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WASHINGTON 
HEALTH  RULES 


A     COMMENTARY     ON      THE      TWELVE 

HEALTH      RULES      FORMULATED     AND 

DISTRIBUTED    BY    THE 


ASSOCIATION   FOR    THE   PREVENTION 

OF   TUBERCULOSIS 

OF  THE  DISTRICT  OF  COLUMBIA 


A  COLLECTION  OF  CHAPTERS  DEALING 
WITH  THE  ESSENTIALS  OF  HYGIENE 
AND  ADAPTED  FOR  SCHOOL  TEACHERS 
AND      FOR     NORMAL     SCHOOL     PUPILS 


19  15 


1         ,     J        fir 


COPYRIGHT,     19  15 
BY  THE  ASSOCIATION  FOR  THE  PREVENTION  OF  TUBERCULOSIS 

WASHINGTON.  D.C. 


•^^LOs' 


TTYGIENE  HELPS  THE  STRONG 
TO  REMAIN  STRONG,  THE 
WEAK  TO  BECOME  STRONG, 
AND,  BY  PREVENTING  SICKNESS, 
LENGTHENS  THE  AVERAGE 
SPAN  OF  HUMAN    LIFE. 


COMMITTEE  ON  PUBLICATIONS 

of  the 

ASSOCIATION  FOR  THE  PREVENTION 
OF  TUBERCULOSIS 

of  the 
DISTRICT  OF  COLUMBIA 


EMILE    BERLINER,    Chairman 
GEN.    GEORGE   M.    STERNBERG 
DR.    ERNEST    C.    SCHROEDER 
DR.   ARTHUR   L.   MURRAY 
REV.    LOUIS    STERN 
WALTER    S.    UFFORD 


CONTENTS. 


INTRODUCTION 


GEORGE  M.  STERNBERG,  M.  D.,  LL.  D.,  Surgeon 
General  U.  S.  Army  (Retired) ;  President  Association 
for  the  Prevention  of  Tuberculosis,  District  of 
Columbia;  ex-President  American  Medical  Associa- 
tion and  ex-President  American  Public  Health  Asso- 
ciation     


GOOD  AIR 

ARTHUR    L.    MURRAY,    M.    D. 


AVOID  HOUSE   DUST 

GEORGE  M.  KOBER,  M.  D.,  Dean  Medical  School 
Georgetown  University;  President  National  Asso- 
tion  for  the  Study  and  Prevention  of  Tuberculosis, 
19 1 5    


SLEEP 


Page 


12 


PURE  WATER 

RUPERT  BLUE,   M.   D.,  D.   Sc,  Surgeon  General  U. 

S.    Public    Health    Service. 

EARLE   B.    PHELPS,   B.    S.,   Professor   of  Chemistry, 

Hygienic  Laboratory,  U.    S.  Public  Health   Service....  16 

SAFE  MILK  AND  CREAM 

DR.  ERNEST  C.  SCHROEDER,  Superintendent  Ex- 
perimental Laboratory,  U.  S.  Bureau  of  Animal  In- 
dustry; National  Delegate  International  Congress  on 
Tuberculosis,    Rome,    1912    24 


WALTER  S.  UFFORD,  Ph.  D.,  Secretary  Associa- 
tion for  the  Prevention  of  Tuberculosis,  District  of 
Columbia   38 


KEEP  CLEAN 


EMILE    BERLINER,    Vice-President    Association    for 
Prevention  of  Tuberculosis,  District  of  Columbia 43 


FOOD 

WILLIAM  C.  WOODWARD,  M.  D..  Health  Officer 
District  of  Columbia,  ex-President  American  Public 
Health    Association     51 

BREATHING  AND  EXERCISE 

CHARLES  W.  RICHARDSON,  M.  D.,  Professor  of 
Laryngology,  George  Washington  University,  District 
of  Columbia   63 

CARE   OF  THE  TEETH 

ALLAN   SCOTT  WOLFE,  D.   D.   S ;o 

LIQUOR  AND  TOBACCO 

HARVEY    W.    WILEY,   M.   D n 

DON'T  NEGLECT  COLDS 

WILLIAM  C.  GWYNN,  M.  D.,  Clinical  Professor  of 
Surgery,  Georgetown  University  Medical  School; 
Chairman  Committee  on  Lectures  Association  for  the 
Prevention  of  Tuberculosis,  District  of  Columbia 84 

SUNSHINE 

REV.   JOHN   VAN    SCHAICK,   Jr.,   D.   D 89 

WASHINGTON  HEALTH  RULES  9^1 


INTRODUCTION 

SANITARL\NS  realize  that  the  success  of  the 
campaign  for  the  prevention  of  any  disease  must 
depend  to  a  great  extent  upon  the  education  of 
the  pubhc  as  regards  the  specific  cause  of  the  disease ; 
the  channels  by  which  it  gains  access  to  the  human 
body  (infection);  the  prevention  of  infection;  and 
the  measures  by  which  the  development  of  the  disease 
may  be  prevented  or  arrested  in  those  already  infected. 
It  is  a  well-established  fact  that  an  attack,  for  in- 
stance, of  tuberculosis,  in  any  of  its  forms,  depends 
upon  two  factors ;  first,  the  introduction  of  the  germ 
(tubercle  bacillus)  ;  second,  the  susceptibility  of  the 
individual.  There  can  be  no  tuberculosis  in  the  ab- 
sence of  the  germ,  and  the  introduction  of  the  germ 
into  the  body  of  an  immune  individual  will  not  give 
rise  to  an  attack  of  tuberculosis.  Fortunately,  adults, 
in  a  good  state  of  health,  have  very  little  susceptibility 
to  the  disease.  The  susceptibility  of  children  is  much 
greater.  But  a  majority  of  those  who  are  infected 
in  childhood,  by  association  with  persons  suffering 
from  pulmonary  tuberculosis,  do  not  become  victims 
of  the  disease.  Still  the  number  who  do  contract 
tuberculosis,  in  one  form  or  another,  is  very  great, 
and,  as  is  well  known,  this  disease  is  the  leading  fac- 
tor in  our  mortality  statistics.  The  fact  that  infection 
usually  occurs  in  childhood  is  now  well  established. 
As  a  result  of  such  infection  some  children  die  earl)i 

(I) 


WASHINGTON  HEALTH  RULES 

of  tubercular  meningitis,  or  tubercular  peritonitis ; 
others  develop  during  youth  tubercular  diseases  of  the 
glands  (scrofula)  or  of  the  bones  and  joints  (hip- 
joint  disease,  ''white  swelling"  of  the  knee,  "Potts 
disease"  of  the  spine,  etc.)  ;  others  suffer  from  pul- 
monary tuberculosis,  which  usually  develops  during 
young  adult  life  (15  to  30  years),  and  is  often  very 
slow  and  insidious  in  its  development.  It  is  now 
generally  recognized  that  in  its  earlier  stages  pul- 
monary tuberculosis  is  a  very  curable  disease.  But, 
unfortunately,  the  earliest  manifestations  of  the  dis- 
ease are  usually  overlooked  or  wilfully  ignored  by 
the  patient,  and,  too  often  are  not  recognized  by  the 
physician,   if  one   is   consulted. 

It  is  evident  that  our  campaign  of  education  must 
have  in  view  the  guarding  of  our  citizens  from  in- 
fection, and  also  from  the  development  of  an  at- 
tack if  infection  has  unfortunately  occurred.  That  a 
slight  infection  may  remain  dormant  for  years  with- 
out any  noticeable  results  is  proved  by  the  large 
number  of  persons,  dying  from  other  diseases,  who 
present  evidence  of  such  infection  at  the  autopsy 
table. 

What  then  are  the  factors  which  give  rise  to  the 
development  of  the  disease,  after  infection,  in  certain 
individuals  and  to  a  lifelong  immunity  from  attack  in 
others?  No  doubt,  the  result  depends  in  part  at 
least,  upon  individual  predisposition,  or  susceptibility, 
which  may,  to  some  extent,  be  inherited.  Those 
who  are  fortunate  enough  to  inherit  a  robust  constitu- 

(2) 


INTRODUCTION 

tion  and  ample  lung  capacity,  are  less  liable  to  the 
disease  than  those  recognized  as  "delicate"  from  birth. 
But  even  more  important  as  predisposing  causes  are 
post-natal  conditions  and  environment,  and  attacks  of 
other  infectious  diseases  which  reduce  the  vital  re- 
sisting power  of  the  individual.  Bad  housing  condi- 
tions, insanitary  surroundings,  insufficient  food,  exces- 
sive fatigue,  dissipation,  are  all  factors  which  tend 
to  overcome  the  normal  resistance  to  the  disease. 
And  certain  diseases  are  especially  liable  to  be  fol- 
lowed by  an  attack  of  pulmonary  tuberculosis,  in  young 
adults  who  have  been  infected  in  childhood.  Among 
these  we  may  mention  especially  measles,  typhoid 
fever  and  pneumonia.  Childbirth  and  injuries  attended 
with  a  considerable  loss  of  blood  may  also  be  included 
among  the  predisposing  causes. 

What  has  been  said  shows  clearly  enough  that  gen- 
eral sanitation,  and  hygienic  living,  are  very  important 
factors  in  the  prevention  of  tuberculosis,  and  fully 
justifies  the  Association  for  the  PreTcntion  of  Tubercu- 
losis of  Washington,  D.  C,  in  the  publication  and 
distribution  of  the  Health  Rules  which  serve  as  a  basis 
for  the  present  publication.  These  Health  Rules  were 
formulated  by  our  Committee  on  Publications  in  1912, 
and  thirty-four  thousand  copies  have  already  been  dis- 
tributed in  the  public  schools  of  the  city.*  They  have 
also  been  widely  distributed  in  other  parts  of  the 
country,  and  have  met  with  general  approval.  In 
order  that  the  twelve  fundamental  topics  referred  to 
in  these  rules  may  be  more  fully  elucidated,  and  with 

*  The  U.  S.  Bureau  of   Indian  Affairs  printed  and  distributed  50.000  of 
these  Health  Rules  among  Indian  homes. 

(3) 


WASHINGTON  HEALTH  RULES 

a  view  io  giving  teachers  the  necessary  data  for  an 
intelHgent  exposition  of  the  several  topics,  twelve 
members  of  the  Association  have  been  requested  to 
write  brief  papers  upon  these  topics.  These  papers 
have  been  read  and  discussed  at  regular  meetings  of 
the  Board  of  Directors  and  after  revision,  vv^here 
deemed  necessary,  have  been  approved  by  a  vote  of  the 
Board.  They  are  now  published,  and  will  be  dis- 
tributed among  the  teachers  in  our  public  schools,  in 
the  hope  that  they  may  serve  a  useful  purpose  in  the 
campaign  of  education  which,  as  indicated  at  the 
outset  of  this  Introduction,  we  believe  to  be  the  most 
essential  measure  in  our  efforts  to  limit  the  ravages 
of  tuberculosis  in  the  District  of  Columbia.  We  feel 
that  the  teaching  of  hygiene  to  the  children  in  our 
public  schools,  with  a  view  to  their  protection  from 
this  and  other  infectious  diseases,  when  these  pupils 
are  made  to  fully  comprehend  the  importance  to  them- 
selves personally  of  conforming  to  the  Health  Rules 
which  have  been  formulated  for  their  benefit,  will  be 
likely  to  make  a  deep  and  lasting  impression.  We 
hope,  too,  that  a  careful  reading  of  this  volume  will 
not  only  convince  teachers  of  the  importance  of  the 
truths  embodied  in  these  twelve  Health  Rules,  but 
will  make  them  feel  their  responsibility,  as  teachers 
of  the  rising  generation,  for  the  dissemination  of  in- 
formation which  is  certainly  not  exceeded  in  impor- 
tance by  any  branch  of  knowledge  they  are  called 
upon  to  teach.  That  'they  may  become  our  co-laborers 
in  the  campaign  for  the  prevention  of  tuberculosis  is 
our  earnest  wish.  ^^^^^  ^^  Sternberg. 

(4) 


GOOD  AIR 
HEALTH  RULE  I 

Avoid  badly  ventilated,  badly  lighted, 
dusty,  dirty,  overheated,  crowded  or  damp 
rooms. 

Air  in  Its  Relation  to  Life  and  Health. 

When  we  consider  that  the  air  we  breathe  extends 
to  every  conceivable  place  and  how  easily  it  may  be 
polhited,  and  how  frequently  the  nature  of  the  sub- 
stance causing  the  pollution  is  such  that  it  can  not 
be  detected  by  our  special  senses,  the  importance 
of  the  "Heahh  Rule"  under  consideration  is  apparent. 

Air  is  essential  to  life.  Everyone  knows  that  if 
we  are  not  provided  with  food  we  become  hungry  and 
should  we  go  a  sufficient  number  of  days  without  it 
our  bodies  show  a  gradual  loss  of  weight  and  we 
finally  die.  However,  if  with  an  abundance,  of  food 
supplied  us,  we  were  confined  within  a  small  space  and 
denied  fresh  air,  we  would  suffer  and  die  in  a  much 
shorter  period  of  time.  Therefore,  fresh  air  is  as 
necessary  to  life  as  pure  food. 

That  we  may  better  understand  what  is  meant  by 
"fresh  air,"  or  ''pure  air,"  let  us  consider  what  air 
really  is.  Air  is  a  mixture  of  gases  the  most  impor- 
tant of  which  is  oxygen,  because  this  gas  is  the  one 
necessary  to  life.  Several  other  gases,  such  as  nitro- 
gen, hydrogen,  argon,  carbon  dioxide,  and  ammonia. 

•    (5) 


WASHINGTON    HEAUTH    RULES 

are  present  in  varying  quantities,  together  with  minute 
particles  of  dust  and  bacteria.  The  purity  of  air  is 
determined  by  the  amount  of  oxygen  it  contains  and 
the  extent  of  its  freedom  from  carbon  dioxide,  for- 
eign gases,  dust  and  bacteria. 

Air  becomes  unwholesome  and  polluted  most  com- 
monly by  dust  and  by  the  exhalations  from  human 
beings  and  animals.  When  breathed  in  by  a  living 
body  the  oxygen  is  extracted  from  the  air  and  ab- 
sorbed into  the  blood,  whereas  carbon  dioxide,  certain 
volatile  organic  products,  moisture,  and  body  heat  are 
eliminated  in  the  expired  air.  Besides  these  elimina- 
tions from  the  lungs  there  are  also  given  off  into  the 
air  surrounding  living  bodies,  volatile  organic  products 
and  heat  from  the  body  surface. 

From  the  earliest  times  it  has  been  known  that 
human  beings  vitiate  the  air  surrounding  their  bodies. 
This  vitiation  has  been  ascribed  to  many  different 
factors.  At  the  present  time,  many  authorities  be- 
lieve that  it  is  not  so  much  a  question  of  an  increase 
in  the  amount  of  carbon  dioxide,  or  a  decrease  in  the 
relative  amount  of  oxygen  in  the  air  of  an  over- 
crowded space,  occupied  by  living  beings,  that  causes 
discomfort  and  illness.  This  discomfort  and  illness  is 
ascribed  by  them  to  stagnation  of  the  air.  The  heat 
and  moisture  being  constantly  given  off  by  the  lungs 
and  body  surface  pass  into  the  surrounding  air, 
which,  in  the  absence  of  an  influx  of  fresh  air  or 
active  circulation,  becomes  surcharged  with  moisture 
and  heat,  seriously  interfering  with  the  further  elimi- 

(6)   . 


GOOD    AIR 

nation  of  body  heat  and  moisture  which  is  demanded 
by  nature  to  preserve  normal  bodily  functions. 

Thus  we  are  led  to  believe  that  the  more  impor- 
tant factors  of  ventilation  are  temperature,  humidity, 
and  air  movement.  The  most  recent  investigations 
along  the  line  of  ventilation  show  that  to  maintain 
the  bodily  functions,  in  a  manner  most  conducive  to 
good  health,  there  should  be  maintained  an  atmos- 
phere which  most  nearly  approximates  out  of  door 
conditions. 

In  the  wide  open  ''out  of  doors"  where  the  wind 
keeps  the  air  constantly  in  circulation,  where  the 
purifying  processes  of  plant  life  remove  the  carbon 
dioxide  and  liberate  oxygen,  where  the  rain  and  the 
dews  wash  out  the  dust,  and  where  the  sunshine  kills 
the  bacteria,  fresh  pure  air  is  always  present. 

But  what  about  indoors  where  plant  life  is  usually 
absent,  winds  do  not  have  access,  and  people  are  con- 
fined to  small  spaces  as  compared  to  the  open?  With- 
in any  given  space,  whether  it  be  the  home,  the  school, 
the  street  car  or  the  moving  picture  theater,  the  air 
will  be  stagnant  and  unwholesome  in  proportion  to  the 
number  of  people  occupying  the  space  and  the  means 
at  hand  for  supplying  fresh  air  to  replace  that  pol- 
luted by  those  present.  By  this,  we  may  see  that  in 
all  enclosed  spaces,  to  have  pure  wholesome  air  to 
breathe,  it  is  absolutely  necessary  that  fresh  air  be 
continually  supplied  from  out  of  doors. 

Many  means  are  employed  to  keep  the  air  in  rooms 

fresh,     The  supplying  of  heated  fresh  air  under  pres- 

(7) 


WASHINGTON    HEALTH    RULES 

sure  is  the  system  commonly  used  in  large  buildings, 
such  as  theaters,  schools  and  churches.  With  this 
system  a  vent  is  provided  in  each  room  near  the 
floor  and  the  heated  air  is  directed  into  the  room  near 
the  ceiling.  By  the  downward  pressure  of  the  fresh 
air  entering,  the  stale  air  in  the  room  is  forced  out 
through  the  vent. 

The  usual  way  to  ventilate  small  rooms,  such  as 
living  rooms,  is  by  means  of  open  windows.  To  get 
the  best  results  from  this  method  two  windows  on 
opposite  sides  of  the  room  should  be  partially  open, 
one  at  the  top  and  one  at  the  bottom.  The  air  in  a 
heated  building  is  lighter  than  the  air  on  the  outside. 
This  being  the  case  the  air  from  within,  in  an  at- 
tempt to  escape,  will  pass  to  the  outside,  producing 
sufficient  suction  to  draw  within  the  room,  cool,  fresh 
air. 

When  the  air  in  a  room  has  become  so  polluted 
and  stagnant  by  body  exhalations  as  to  become  un- 
pleasant, and  dangerous,  several  means  are  at  hand  to 
detect  the  same.  First  there  is  a  sense  of  heaviness 
to  the  air  and  on  entering  such  a  room  from  the  out- 
side one  notices  a  distinct  odor.  Next  there  comes 
over  one  a  feeling  of  oppression  and  difficulty  in 
breathing,  which  may  develop  into  a  dizziness.  Often- 
times, however,  air  which  may  not  be  so  stagnant  as 
to  cause  the  above  conditions  to  present  themselves, 
is  yet  far  from  a  healthy  air  to  breathe.  If  you  knew 
that  certain  food  you  were  about  to  take  into  your 
mouth  was  not  clean  you  would  not  eat  it.     Do  you 

^      (8) 


GOOD    AIR 

take  the  same  precaution  in  regard  to  the  air  you  take 
into  your  kings?  , 

Many  bacteria  and  germs  of  disease  live  and  per- 
sist much  longer  in  stale  polluted  air  than  in  fresh  air. 
Dark,  damp,  dirty,  and  poorly  ventilated  rooms  are 
favorable  for  preserving  the  vitality  of  the  germs 
which  cause  consumption,  pneumonia,  grippe,  and  con- 
tagious colds.  People  who  occupy  such  rooms  in- 
variably show  a  higher  disease  rate  and  death  rate 
than  those  who  pass  most  of  their  time  in  the  open, 
or  in  light,  dry,  well  ventilated  quarters. 

From  the  above  it  may  be  seen  that  should  you  de- 
sire to  be  strong  and  healthy  you  should  spend  just 
as  much  of  your  time  out  of  doors  as  possible.  Of 
course  it  is  impossible  to  be  in  the  open  all  the  time, 
but  when  compelled  to  be  within  doors  one  should 
always  be  careful  to  see  that  a  liberal  supply  of  fresh 
air  enters  the  room  one  occupies. 

The  effect  of  fresh  air  on  our  every  day  activities 
is  far  greater  than  many  of  us  realize.  As  an  illus- 
tration of  the  effect  of  a  liberal  supply  of  pure  air  to 
children  in  school  I  would  like  to  call  attention  to 
certain  facts  which  have  been  observed  in  careful 
studies  made  of  classes  in  "fresh  air  schools." 

The  pupils  of  fresh  air  classes,  in  ordinary  school 
rooms,  the  windows  of  which  are  kept  continually  open, 
apon  careful  and  repeated  examination,  invariably  show, 
during  a  given  period  of  time,  an  increase  in  weight 
and  height  greater  than  that  of  children  of  the  same 
type  occupying  ordinary  class  rooms  where  no  par- 

(9) 


WASHINGTON    HEALTH    RULES 

ticular  attention  is  paid  to  ventilation.  The  usual 
absence  on, account  of  sickness  is  also  much  less  amone 
the  pupils  of  the  fresh  air  classes.  Late  in  the  after- 
noon, near  closing  time,  the  pupils  in  the  fresh  air 
classes  appeared  as  fresh,  alert  and  ready  for  their 
lessons  as  when  they  arrived  in  the  morning,  whereas 
pupils  in  the  ordinary  class  rooms,  by  the  middle  of 
the  afternoon  session,  were  found  to  be  languid,  tired 
and  it  was  next  to  impossible  to  hold  their  attention 
to  the  lessons  upon  which  they  were  engaged.  The 
children  in  the  fresh  air  classes  appeared  to  enjoy 
their  studies,  being  bright  eyed  and  rosy  cheeked,  but 
the  pupils  in  the  ordinary  class  rooms  were  pale,  heavy 
eyed  and  appeared  to  be  working  under  a  strain. 

Recent    studies    in    ventilation    have    had    a    most 
wholesome  effect  in  shaping  modern  ideas  as  to  the 
effects  of  drafts.    The  present  view  of  many  authori- 
ties  as   to   the   effect  of   drafts   is   that   with   proper 
clothing  protection,  drafts  of  fresh  air  are  not  harm- 
ful.   In  many  cases   where  the  persons   exposed  are 
healthy  and  robust  this  is  undoubtedly  true.    However, 
it  should  be  borne  in  mind  'that  direct  currents  of  cold 
air  from  outside,  when  the  difference  in  the  tempera- 
ture within  and  without  is  very  marked,  may  in  some 
persons  cause  a  congestion  of  the  part  of  the  body 
against  which  the  air  current  is   directed.     Persons 
who  are  debilitated  or  whose  general  condition  is  be- 
low par,   although  oftentimes  benefited  by  a  bounti- 
ful supply  of  fresh  air,  should  not  be  subjected  to 
direct  drafts  of  air  of  a  decidedly  lower  temperature 

(10) 


GOOD    AIR 

than  the  room  occupied.  Of  the  diseases  and  con- 
ditions directly  or  indirectly  ascribed  to  exposure  to 
cold  and  drafts,  by  the  older  text  books,  recent  studies 
tend  to  show  that  most  of  these  conditions  are  usually 
due  to  bacterial  infections. 

The  beneficial  effect  of  fresh  air  in  sleeping  rooms 
should  be  more  generally  appreciated.  Where  the 
windows  are  kept  open  in  sleeping  rooms  rest-dis- 
turbing dreams  are  rare  and  upon  awaking  in  the 
morning  the  sleeper  feels  refreshed  and  ready  for  a 
day's  work. 

People  should  always  consider  the  purity  of  the  air 
they  breathe  just  as  much  as  they  consider  the  purity 
of  the  food  they  eat.  Places  not  provided  with  proper 
means  of  ventilation  should  be  shunned  if  health  is 
desired.  Crowded,  ill-lighted,  overheated,  and  poorly 
ventilated  rooms  are  the  very  best  friends  of  whoop- 
ing cough,  scarlet  fever,  diphtheria,  measles,  colds, 
tuberculosis,  and  pneumonia,  as  the  danger  of  con- 
tagion is  much  greater  under  such  circumstances  and 
the  resistance  of  the  body  against  infection  is  reduced. 

We  may  accept  with  little  fear  of  contradiction  the 
fact  that  the  open  air  is  most  valuable  in  many  dis- 
eased and  abnormal  conditions,  such  as  tuberculosis, 
pneumonia,  anemias,  heart  disease,  and  various  ner- 
vous disorders.  If  the  open  air  is  most  useful  in  the 
cure  of  these  pathological  conditions  is  it  not  safe  to 
assume  that  the  fresh  air  of  the  open  is  of  great  value 
in  the  prevention  of  these  diseases?  That  this  is  true 
has  been  amply  demonstrated  by  observation  and  com- 
parative statistics. 

ARTHUR  L.   MURRAY 
(II) 


AVOID   HOUSE   DUST 
HEALTH  RULE  II 

Breathing  dust,  notably  house  dust,  often 
causes  disease. 

Have  no  tacked  down  carpets  and  mattings. 
Have  loose  pieces  or  rugs,  and  clean  them 
frequently  outdoors. 

Use  a  hair  broom  for  your  floors  and  keep 
lower  sashes  closed  while  sweeping  or  dust- 
ing.    Open  upper  sashes  if  possible. 

Never  sweep  rooms  with  a  broom  that 
raises  dust. 

Household  dust  is  extremely  objectionable  because 
dust  and  germs  always  go  hand  in  hand.  Uffelmann, 
a  well  known  authority  on  ithe  subject,  found  that 
while  the  outer  air  contained  only  250  germs  per 
cubic  mete'r,  the  air  of  his  library  contained  2,900,  of 
his  sitting  room  7,500,  of  his  bedroom  12,500,  and 
the  air  of  a  living  room  of  a  workingman's  family 
as  many  as  31,000  germs.  He  also  demonstrated  that 
they  increased  after  disturbing  the  dust  of  the  rooms 
by  featherdusters  or  by  slamming  the  doors,  showing 
that  they  actually  cling  to  the  household  dust.  If  the 
dust  should  happen  to  contain  the  germs  of  itubercu- 
losis,  from  carelessly  expectorated  sputum,  or  of  any 
other  infectious  disease  which  may  have  been  carried 
into  the  house  upon  the  soles  of  foot-wear,  or  the 
bottom  of  skirts,  such  dusit  may  prove  a  source  of 
danger,  especially  to  children. 

(12) 


AVOID  HOUSE  DUST 

It  should  be  remembered  that  the  habitual  inhala- 
tion of  any  kind  of  dust  is  harmful,  as  it  predisposes 
to  diseases  of  the  respiratory  passages,  and  also  irri- 
tates the  mucous  membranes  of  the  eyes,  nose  and 
throat.  While  75  per  cent  of  the  dust  lodges  in  the 
nose  and  throat  or  finds  its  way  into  the  stomach, 
the  remainder  lodges  on  the  mucous  membrane  of  the 
air  passages  of  the  lungs.  Here  the  dust  acts  as  a 
foreign  body,  and  nature  makes  an  effort  to  expel  it 
by  coughing,  by  means  of  which  the  coarser  particles 
may  be  expectorated.  Nature'  also  provides  means  for 
the  elimination  of  the  finer  particles  of  dust,  but  when 
the  protective  forces,  such  as  the  ciliated  epithelium 
and  white  corpuscles  of  the  blood,  are  imposed  upon 
too  much,  itheir  function  is  impaired  and  much  of 
the  dust  remains.  , 

Dust  also  acts  as  an  irritant  and  causes  catarrhal 
conditions  of  the  mucous  membranes  and  even  more 
serious  chronic  inflammation  of  the  respiratory  organs. 
The  chronic  inflammatory  conditions  thus  produced 
naturally  favor  infection  with  the  tubercle  bacillus,  or 
may  light  up  a  latent  infection  contracted  in  early  life. 

It  is  now  generally  held  that  in  the  majority  of  in- 
stances, probably  in  90  per  cent,  tuberculosis  is  con- 
tracted in  childhood  and  the  germs  remain  dormant 
until  adverse  conditions  create  a  favorable  soil  for 
their  growth  and  development.  Such  a  soil  is  usually 
found  in  persons  whose  body  has  been  weakened  from 
any  of  the  numerous  causes  which  may  produce  this 
result  such  as  a  previous  attack  of  sickness,  malnutri- 

(13) 


WASHINGTON    HEALTH    RULES 

tion,   loss  of  sleep,  vice  and   dissipation   and  all  the 
home  factors  already  alluded  to. 

The  influence  of  dust  on  the  prevalence  of  this  dis- 
ease is  strikingly  shown  by  the  fact  that  the  tubercu- 
losis rate  among  472,000  males,  in  the  United  States, 
exposed  in  15  occupations  to  the  inhalation  of  dust, 
was  2.29  per  1,000,  against  a  rate  of  1.55  for  all  oc- 
cupied males.  Statistics  collected  by  Sommerfeld 
show  that,  with  an  average  tuberculosis  death  rate  of 
4.93  per  1,000  in  the  population  of  Berlin,  the  rate 
in  nondusty  trades  was  2.39  and  in  dusty  trades  5.42, 
showing  that  the  death  rate  from  tuberculosis  in  dusty 
trades  is  about  double  that  of  others. 

House  Furnishings.  •  For  reasons  already  given, 
there  should  be  no  accumulation  of  dust  in  any  part 
of  the  house.  Hygiene  condemns  all  interior  orna- 
mentation and  unnecessary  furniture  which  will  serve 
as  dust  and  germ  traps,  such  as  heavy  cornices,  elab- 
orate mouldings  of  doors  and  window  frames,  ward- 
robes, cumbersome  draperies,  tacked  down  carpets 
and  matting.  Hygiene  on  the  other  hand  approves  of 
neatly  polished  floors,  with  small  rugs  which  can  be 
easily  taken  up  and  frequently  cleaned  outdoors; 
curves  instead  of  cornices  and  angles;  plain  window 
and  door  trimmings ;  smooth  and  nonabsorbent  walls, 
instead  of  embossed  wall  paper;  and  simplicity  of 
furniture.  In  brief,  everything  which  will  prevent 
the  collection  of  dust  and  germs  and  facilitate  their 
removal  may  be  regarded  as  hygienic.  So  for  ex- 
ample, a  plain,  tinted,  smooth  wall,  or  the  varnished 

(14) 


AVOID    HOUSE   DUST 

wall  papers,  which  can  be  cleaned  with  a  damp  cloth, 
are  in  point  of  health  superior  to  the  embossed  silk 
hangings  and  tapestries  of  the  rich  man's  home.  The 
same  is  true  of  simple    picture  frames,  and  furniture. 

House-cleaning.  The  object  of  house  cleaning  is 
primarily  to  get  rid  of  ithe  dust  and  germs.  In  sweep- 
ing, it  is  desirable,  therefore,  to  open  the  upper  win- 
dows, but  to  keep  the  lower  sashes  and  the  door 
leading  into  the  hall  closed,  so  that  the  dust  may  not 
be  wafted  back  into  other  parts  of  the  house,  and  into 
the  noses  and  lungs  of  people  that  are  about,  because 
the  cool  outer  air  invariably  rushes  into  the  lower 
sashes  when  these  are  raised,  while  the  warmer  air  of 
the  room  passes  out  at  the  top  when  the  upper  sashes 
are  lowered.  If  lambrequins  or  curtains  obstruct,  it 
is  best  not  to  open  any  window  during  sweeping  and 
dusting  unless  a  strong  draught  from  the  other  side 
of  the  room  can  blow  the  dust  out. 

Sweeping  should  be  done  by  means  of  hair  brooms, 
carpet  sweepers  or  vacuum  cleaners.  Always  avoid 
brooms  that  raise  dust.  The  dusting  in  the  absence 
of  vacuum  cleaning  should  be  done  with  a  soft  damp 
cloth,  frequently  rinsed.  Under  no  circumstances 
should  ithe  feather  duster  be  used  inside  of  the  house, 
as  it  does  not  remove,  but  simply  displaces  the  dust. 
If  the  cracks  in  the  floors  have  been  neatly  filled,  and 
the  floors  themselves  oiled  or  waxed,  they  can  be 
cleaned  with  a  damp  cloth  much  more  effectively  than 
by  the  tiresome  process  of  scrubbing,  a  drudgery  to 
every  neat  housekeeper. 

GEORGE    M.    KOBER 
(15) 


PURE   WATER 
HEALTH  RULE  III 

Drink  pure  water. 

Avoid  water  from  shallow  and  unprotected 
wells,  and  from  ponds  and  streams. 

If  in  doubt,  boil  the  water. 

Washington  water  is  safe  to  drink. 

Avoid  public  drinking  cups. 

A  sufficient  quantity  of  water  in  one  form  or  another 
is  quite  essential  to  the  existence  and  normal  activity 
of  every  living  thing.  Jiist  as  a  pond  or  lake,  deprived 
of  its  continuous  supply  of  replenishing  water,  first 
becomes  stagnant  and  overburdened  with  the  waste 
products  of  the  life  it  harbors,  and  finally  dries  up  and 
disappears,  so  the  living  organism,  be  it  plant  or  ani- 
mal, land  or  aquatic  is  dependent  for  its  wellbeing 
upon  a  continuous  flow  of  water  through  its  system. 

Plants  utilize  the  flowing  sap  for  the  distribution  of 
food  and  mineral  salts.  The  higher  animals  possess 
more  complex  circulatory  systems,  but  in  each  case 
water  is  the  transporting  medium,  the  one  liquid  sub- 
stance common  to  all  forms  of  life. 

In  the  human  body,  water  not  only  furnishes  the 
transportation  system,  carrying  the  materials  of  con- 
struction to  the  points  where  they  are  needed,  but  it 
is  also  the  cleansing  and  flushing  system  of  the,  body, 

(t6) 


PURE  WATER 

carrying  away  the  waste  products  of  life  through 
the  various  channels  of  excretion.  Upon  the  skin, 
as  perspiration  and  from  the  lungs,  it  also  cools  the 
body  by  evaporation.  Without  this  cooling  effect 
the  proper  thermal  regulation  of  the  body  could  not  be 
maintained  in  warm  weather,  and  man  would  be 
forced  to  migrate  like  the  birds,  or  confine  his  habita- 
tion to  the  colder  regions  of  the  world. 

The  need  for  water  at  all  times  and  larger  quantities 
during  warm  weather  is  therefore  a  fundamental 
physiological  fact. 

This  necessary  water  is  obtained  in  part  in  our 
food  and  food  beverages,  but  additional  water  must 
be  had  to  meet  the  demands  of  the  body,  and  a  free 
use  of  water  for  drinking  is  one  of  Nature's  best 
medicines. 

Avoid  Impure  Water. 

The  drinking  of  pure  water  is  a  health-giving  neces- 
sity, but  the  drinking  of  impure  water  often  leads  to 
sickness  and  death.  Water  as  Nature  prepares  it  is 
the  purest  water  known  to  science.  It  is  distilled  by 
evaporation  from  the  seas,  lakes,  and  rivers,  and  by 
condensation  in  the  pure  cold  upper  strata  of  the  at- 
mosphere. In  falling  to  the  earth  as  rain,  it  absorbs 
small  quantities  of  the  gases  of  the  air,  and  washes 
from  the  air  much  of  the  smoke,  dust  and  floating 
debris.  Coming  into  contact  with  the  soil  it  dissolves 
mineral  and  organic  materials  on  its  way  to  brook  or 
river.    Worst  of  all  it  is  deliberately  polluted  by  man. 

(17) 


WASHINGTON    HEALTH    RULES 

The  sewage  of  cities,  or  of  country  homes,  the  drain- 
age from  manured  fields,  and  the  multitudinous  wastes 
of  great  industries  are  conducted  or  find  their  way 
eventually  to  the  streams.  Even  the  little  mountain 
brook,  ever  the  inspiration  of  the  poet  and  the  joy 
of  the  nature-lover,  may  carry  in  its  innocently  spark- 
ling flow  the  drainage  from  a  careless  farmer's  privy 
or  direct  pollution  from  one  who,  while  enjoying  its 
beauty,  will  not  hesitate  to  ravish  its  innocence  and 
purity.  The  use  of  the  larger  streams  for  carrying 
away  the  wastes  of  cities  has  come  to  be  an  economic 
necessity.  Purification  of  these  wastes  is  being  de- 
manded by  the  sanitary  authorities  and  will  become 
more  and  more  a  part  of  the  program  of  civic  devel- 
opment. After  all  is  done  that  can  be  done,  however, 
streams  flowing  by  large  cities  will  inevitably  remain 
polluted  to  an  unavoidable  extent.  This  much  must 
be  accepted.  But  he  who  wilfully  or  carelessly  per- 
mits the  preventable  pollution  of  a  pure  stream  offends 
against  the  highest  ideals  of  society,  the  ideals  of 
health,  of  purity,  and  of  decency. 

A  portion  of  the  water  which  falls  to  the  earth  as 
rain,  finds  its  way  by  seepage  to  that  great  body  of 
water  known  as  the  ground-water.  It  may  later 
emerge  as  a  spring,  rejoining  the  surface  waters  of 
running  streams,  and  in  dry  weather  the  surface  water 
may  replenish  the  diminished  ground-water  supply. 
This  ground-water  is  doubly  protected  against  pol- 
lution. It  is  for  the  most  part  out  of  reach  of  ordi- 
nary pollution  being  safely  hidden  beneath  the  soil. 

(i8) 


PURE    WATER 

Furthermore  the  soil  is  Nature's  filter  and  exerts  a 
wonderful,  purifying  action  whereby  a  polluted  surface 
water,  upon  entering  the  ground,  is  cleansed  of  its 
objectionable  impurities.  So  for  ages  the  spring,  issu- 
ing from  the  mountainside,  has  been  regarded  as  the 
emblem  of  purity.  But  again  man's  ignorance  and  in- 
terference have  undone  that  which  was  good.  The 
concentration  of  polluting  material,  and  especially  of 
that  most  dangerous  material,  human  excrement, 
within  the  surface  layer  of  the  soil,  overtaxes  the  nat- 
ural purifying  resources  of  the  soil  and  permits  the 
passage  of  unpurified  and  dangerous  pollution  into 
the  body  of  ground-water  below.  This  is  always  the 
case  with  any  kind  of  privy  which  permits  its  con- 
tents to  seep  directly  into  the  ground,  and  especially 
so  with  the  deep  pit  privy.  The  water  in  the  vicinity 
will  become  polluted  and  any  nearby  shallow  well, 
which  is  merely  a  hole  reaching  down  into  that  slowly 
flowing  underground  stream,  will  draw  from  that  pol- 
lution. A  deep  well,  which  is  the  technical  name  of 
a  well  passing  in  a  tight  casing  through  the  upper 
water-bearing  strata,  and  through  an  impervious  clay 
or  rock  stratum,  to  lower  underground  streams,  is 
almost  always  sufficiently  protected.  The  waters 
which  it  reaches  come  from  remote  distances,  and  any 
initial  pollution  will  have  been  removed  during  their 
passage.  Only  in  limestone  formations,  where  the 
deep  waters  may  be  true  underground  streams,  flow- 
ing for  miles  in  open  tunnels  and  caverns,  is  there 
danger  from  remote  pollution.     The  safety  of  a  deep 

(19) 


WASHINGTON    HEALTH    RULES 

well  depends  of  course  upon  the  tightness  of  its  casing 
and  the  complete  exclusion  of  nearby  shallow  drain- 
age. A  flowing  well  gives  positive  evidence  of  the 
exclusion  of  drainage  from  any  lower  level  than  its 
outlet. 

Surface  streams,  ponds  and  shallow  ground-waters 
are  therefore  subject  to  pollution,  and  their  use  for 
drinking  and  domestic  purposes  is  offensive  to  the 
sense  of  decency.  But  much  more  can  and  must  be 
said  against  them.  Contagious  and  infectious  diseases 
are  transmitted  from  one  victim  to  another,  from  the 
sick  to  the  well,  by  means  of  germs  or  bacteria.  These 
germs  most  commonly  enter  the  body  by  the  mouth 
or  nose,  in  food,  drink  or  the  breath,  and,  multiplying 
enormously,  are  discharged  in  the  excreta.  This  is  es- 
pecially true  of  that  most  dreaded  and  most  common 
of  the  so-called  water-borne  diseases,  typhoid  fever. 
Water,  polluted,  however  slightly,  with  human  excre- 
ment, may  contain  the  germs  of  disease.  Surface 
waters,  brooks  and  ponds,  and  shallow  wells  near 
dwelling  houses,  may  be  so  polluted  and  may  carry 
disease.  The  presence  of  pollution  is  not  detectable 
through  the  senses,  for  a  very  dangerous  water  may  be 
sparkling,  clear  and  sweet  in  taste  and  smell.  All  such 
waters  therefore,  however  innocent  in  appearance, 
may  be  dangerous  and  are  to  be  avoided. 

They  should  be  avoided  not  only  for  drinking,  but 
also  for  any  use  in  connection  with  uncooked  food, 
such  as  the  washing  of  green  vegetables.  For  dish 
washing  also  it  is  of  first  importance  that  only  pure 
or  boiled  water  be  used. 

(20) 


PURE   WATER 

Boiled  Water  is  Safe. 

But  of  course  most  of  us  must  use  such  surface  or 
shallow-well  waters,  for  deep  ground-water  is  not  al- 
ways to  be  had.  Fortunately  we  may  eliminate  the 
danger  by  one  or  another  device.  The  simplest,  most 
readily  accessible  and  surest  of  these  devices  is  heat. 
If  water  be  heated  until  it  just  boils  all  dangerous 
germ  life  will  be  destroyed.  Boiled  water  is  safe 
water.  There  is  none  safer.  Whether  upon  the  farm, 
in  camp,  or  in  a  city  having  a  suspicious  water  sup- 
ply, this  simple  safe-guard  is  open  to  all.  Boil  the 
Water  and  Kill  the  Germs. 

Cities  have  other  remedies,  more  costly  to  install, 
more  difficult  to  operate,  and  not  one  bit  better.  These 
devices  are  filters,  assisted  by  various  coagulants  and 
disinfectants.  The  type  of  filter  and  the  nature  of  the 
treatment  vary  from  place  to  place  and  from  time  to 
time  according  to  the  character  of  the  water.  A  prop- 
erly designed  and  operated  filter  may  render  even  a 
badly  polluted  water  hygienically  safe  and  pure.  The 
water  of  Washington  although  but  little  polluted  in 
the  first  place,  being  taken  from  the  Potomac  above 
the  Great  Falls,  is  thus  treated  and  is  of  the  first  qual- 
ity. Many  other  cities  are  equally  well  protected. 
Others,  less  fortunate,  furnish  to  their  citizens  and 
guests,  unfiltered  and  unpurified  river  water.  Epi- 
demics of  typhoid  fever,  high  infant  mortality  from 
intestinal  disturbances,  and  high  sickness  and  death 
rates  characterize  these  cities.    The  so-called  "summer 

(21) 


WASHINGTON    HEALTH    RULES 

typhoid"  or  "vacation  typhoid"  is  but  one  measure  of 
the  imperfect  sanitary  condition  under  which  travelers 
and  vacationists  are  forced  to  live.  Fortunately  these 
conditions  are  being  recognized  and  remedied,  and 
those  who  may  choose  the  course  of  their  travels  or 
select  their  summer  vacation  resorts  will  do  well  to 
make  thorough  inquiry  into  the  sanitary  conditions  of 
the  places  they  would  visit. 

The  large  city  filters  must  not  be  confused  with  the 
little  so-called  filters  often  offered  for  sale  by  pedlars 
or  others.  There  are  few,  if  any,  of  these  devices  that 
will  be  of  any  advantage  to  a  domestic  supply.  Cer- 
tainly none  of  the  cheap  affairs  which  screw  onto  the 
faucet  are  of  the  slightest  value.  With  careful  opera- 
tion certain  of  the  more"  expensive  types,  employing 
fine  porcelain  tubes,  are  efficient;  but  for  a  household 
device  to  treat  a  dangerous  water  some  form  of  heat 
treatment,  automatic  boiling  or  distilling  apparatus, 
or  disinfection  by  ozone  or  ultra-violet  light  is  to  be 
recommended. 

Some  of  the  standard  brands  of  bottled  water  are 
carefully  looked  after  and  safe.  Unknown  brands 
and  especially  all  local  bottled  ''spring  waters"  are  to 
be  looked  upon  with  suspicion  in  the  absence  of  defi- 
nite information  as  to  their  source  and  manner  of 
handling.  Most  of  them  furnish  little  guarantee  of 
original  purity,  while  the  opportunity  for  contamina- 
tion is  great.  Sterilization  of  the  bottles  is  a  first 
essential,  for  they  are  often  taken  direct  from  the  sick 
room  to  be  refilled  and  redistributed. 

(22) 


PURE   WATER 

Avoid  Public  Drinking  Cups. 

The  drinking  water  furnished  on  trains  and  steam- 
boats, engaged  in  interstate  traffic,  is  now  under  the 
supervision  of  the  U.  S.  Pubhc  Health  Service. 

Finally  there  is  danger  between  the  faucet  and  the 
lips.  Pure  and  safe  drinking  water,  run  into  a  cup 
just  used  by  a  tuberculosis  person  may  carry  to  the 
lips  of  the  next  user  the  germs  of  tuberculosis.  The 
same  is  true  of  diphtheria  and  many  of  the  diseases  of 
children.  The  public  drinking  cup  is  fortunately  pass- 
ing away  and  will  soon  be  no  longer  known  among 
decent  people.  Collapsible  metal  cups  for  travelers 
and  the  ready  accessibility  of  bubble  fountains  and 
of  individual  paper  cups  in  most  places  make  it  pos- 
sible to  avoid  this  danger  without  inconvenience.  In 
the  schools,  even  after  the  abolition  of  the  public  cup, 
it  is  necessary  to  constantly  warn  against  the  "bor- 
rowing" of  the  private  cup,  a  too  common  practice. 

In  summary  then : 

Surface  water,  ponds  and  brooks,  may  be  polluted. 
Shallow-well  water  may  be  polluted. 
Polluted  water  may  contain  the  germs  of  disease. 
Boiling  the  water  kills  the  germs. 
Boiled  water  is  safe  water. 
.Well  filtered  city  water  is  safe  water. 
The  purest  water  in  a  public  drinking  cup  is  dan- 
gerous. 

RUPERT  BLUE 
EARLE  B.  PHELPS 

{23) 


SAFE  MILK  AND  CREAM 
HEALTH  RULE  IV 

Tuberculosis,  typhoid  fever,  and  other 
diseases  are  often  caused  by  drinking  raw 
milk  and  raw  cream. 

Get  milk  properly  pasteurized,  or  home- 
pasteurize  it,  or  simply  scald  it. 

All  cream,  including  that  used  for  ice  cream 
and  butter,  should  be  properly  pasteurized 
to    be  safe. 

Diseases  often  attack  us  through  food.  The  pur- 
poses of  this  chapter  are  to  show  that  milk  is  the 
most  important  food  in  this  respect  and  to  define  what 
we  must  do  to  escape  the  dangers  that  menace  us 
through  its  use. 

Milk  is  an  exceedingly  delicate  and  complex  liquid 
secreted  by  mammals  for  the  nourishment  of  their 
young.  It  contains,  in  easily  digested  combinations 
and  admirable  proportions  for  the  needs  of  young 
mammals,  everything  we  must  derive  from  food  to 
remain  alive  and  well.  Though  the  milk  of  every 
species  of  mammals  contains  all  the  essential  elements 
of  food,  that  of  each  species  is  particularly  suited  for 
its  young;  hence,  the  milk  of  cows  is  the  best  milk 
for  calves ;  that  of  mares  for  colts ;  and  that  of  women 
for  babies. 

Nature  provided  that  milk  should  pass  directly  from 
the  body  of  a  mother  into  the  mouth  of  her  young, 

(24) 


SAFE    MILK    AND    CREAM 

without  previous  'exposure  to  air,  dust,  milk  utensils, 
the  hands  and  other  parts  of  milkers,  variations  of 
temperature  or  anything  that  may  contaminate  it  or 
change  its  character.  Used  in  this  way,  the  milk 
of  a  healthy  mother  is  a  perfect  food,  and  every 
healthy  mother  should  strive  to  feed  her  baby  in  the 
natural  w^ay. 

No  one  who  knows  how  much  commoner  sicknesses 
and  deaths  are  among  artificially  or  bottle-fed  babies 
than  among  those  fed  in  the  natural  w^ay  can  doubt 
that  every  mother  should  look  upon  feeding  her  baby 
in  the  natural  way  as  a  sacred  duty.  It  is  claimed  by 
those  who  have  studied  the  subject  that  ten  bottle-fed 
babies  die  to  one  fed  in  the  natural  way. 

Milk  removed  from  the  animals  by  which  it  is 
secreted  through  other  means  than  the  mouths  of 
their  young  varies  enormously  in  quality.  It  may  be 
a  very  valuable  and  safe  or  a  positively  dangerous 
food,  and  just  w^hich  it  is  depends  upon  the  amount 
and  character  of  the  impurities  it  contains  and  the 
changes  it  has  undergone. 

Impurities  and  changes  that  our  senses  can  detect 
should  lead  us  to  discard  milk  at  once  as  unfit  to 
enter  our  mouths.  We  must  use  our  senses  to  pro- 
tect our  health ;  our  eyes,  noses  and  tongues  should 
make  sure  that  our  food  looks,  smells  and  tastes  right. 
To  reject  milk  which  shows  a  sediment  or  a  deposit 
on  standing,  or  is  unnatural  in  its  appearance,  odor 
or  taste,  is  a  wise  and  urgently  necessary  precaution. 
But  this  alone  does  not  give  us  sufficient  protection,  as 

(25) 


WASHINGTON    HEALTH    RULES 

the  more  serious  dangers  that  menace  us  through 
milk  remain  hidden  until  their  presence  is  demon- 
strated, too  late,  by  the  harm  they  have  done.  These 
dangers  are,  expressed  in  one  word,  bacteria. 

In  addition  to  being  an  excellent,  nutritious  food 
when  pure  and  fresh  for  babies,  older  children  and 
adults,  the  use  of  which  should  be  encouraged  and 
increased  and  not  discouraged,  milk  is  also  a  nearly 
perfect  food  for  bacteria,  or  those  microscopic,  vege- 
table organisms  commonly  spoken  of  as  germs,  and 
many  of  which  are  true  disease  germs.  Nothing  we 
use  as  food  is  a  more  favorable  medium  for  the 
growth  and  multiplication  of  bacteria.  Milk  contains 
the  nourishment  bacteria  require,  dissolved  and  ready 
for  use,  and,  as  milk  is  opaque,  it  hides  the  germs 
from  view  and  shields  them  against  light  or  their 
greatest  natural  enemy. 

Bacteria  may  be  divided  into  three  classes,  as  fol- 
lows :  Those  probably  harmless ;  those  harmless  in 
small  but  dangerous  in  large  numbers,  and  those  al- 
ways dangerous  and  more  so  as  their  numbers  in- 
crease. One  class  can  not  be  distinguished  from  the 
other  in  the  short  time  between  milking  and  the  use 
of  milk  as  food. 

The  total  exclusion  of  bacteria  from  milk  is  im- 
possible. The  freshest,  purest  and  best  milk  from  a 
healthy  cow  or  other  mammal  contains  a  small  num- 
ber. The  small  number,  swallowed  by  a  young  animal 
with  milk  obtained  from  its  healthy  mother  in  the 
natural  way,  do  no  harm,  but  in  milk  which  is  not 

(26) 


SAFE    MILK    AND    CREAM 

immediately  swallowed  they  may  increase  with  sur- 
prising rapidity.  For  example,  milk  with  only  lo 
bacteria  per  cubic  centimeter  (about  i6  drops),  at 
the  beginning  may  contain  over  60,000  per  cubic  centi- 
meter after  it  has  been  kept  at  a  comfortable  room 
temperature  24  hours,  and  over  3,500,000  per  cubic 
centimeter  at  the  end  of  40  hours.  , 

Cold  checks  and  warmth  hastens  the  multiplication 
of  bacteria ;  hence,  milk  should  be  cooled  quickly  after 
it  is  milked  and  kept  cold  until  it  is  used.  It  should 
also  be  kept  covered,  to  exclude  dust,  flies  and  other 
impurities.  Dust  and  dirt  contain  many  bacteria  and 
the  bodies  of  flies  are  filthy. 

After  milk  has  been  delivered  by  a  dealer  we  must 
not  imagine  the  multiplication  of  bacteria  in  it  stops. 
Unless  it  is  kept  cold  and  covered,  though  its  quality 
is  excellent  at  the  time  of  deHvery,  it  may  not  be 
wholesome  food  a  few  hours  later.  The  dairyman 
or  dealer  cannot  be  held  responsible  for  what  hap- 
pens to  milk  after  it  has  passed  beyond  his  care,  and 
milk  with  only  a  reasonable  number  of  bacteria  at  the 
time  of  delivery,  unless  it  is  kept  cold  and  covered, 
may  contain  over  400,000,000  per  teaspoonful  24  hours 
later. 

Unfortunately  much  milk  is  left  at  the  houses  of 
consumers  early  in  the  morning  and  not  taken  in 
until  several  hours  later.  When  this  is  the  case  pro- 
vision should  be  made  to  have  it  so  placed  that  the 
sun  cannot  shine  on  it  and  animals,  like  dogs  and 
cats,  cannot  reach  it. 

{27) 


WASHINGTON    HEALTH    RULES 

The  supposedly  harmless  bacteria  and  those  harm- 
ful in  large  numbers  should  be  controlled  in  milk  by 
care  and  cleanliness ;  by  having  only  healthy  and 
ckan  animals  in  dairy  herds ;  by  stabling  such  animals 
in  clean  and  well  ventilated  stables  and  providing 
^ood  pastures  for  them ;  by  feeding  them  wholesome, 
clean  food;  by  having  clean,  pure  v/ater  supplies  on 
dairy  farms ;  by  cleaning  dairy  utensils  in  a  way 
that  kills  bacteria ;  by  insisting  on  the  greatest  cleanli- 
ness of  person  and  habit  among  dairy  employees; 
by  making  the  time  between  milking  and  the 
delivery  of  milk  to  the  consumer  as  short  as  possible ; 
by  using  every  reasonable  precaution  to  guard  milk 
against  contamination  and  the  multiplication  of  those 
bacteria  in  it  that  cannot  be  excluded,  or,  plainly,  by 
using  up-to-date,  approved  methods  in  the  production 
and  distribution  of  milk  and  proper  precautions  to 
keep  it  pure  and  wholesome  after  it  has  been  de- 
livered. 

Impure,  bacteria-laden  milk,  even  when  it  contains 
no  bacteria  of  the  class  known  as  true  disease  germs, 
is  dangerous.  Strong,  vigorous  persons,  whose  re- 
sistance to  disease  is  high,  often  use  it  without  being 
noticeably  affected  by  it,  but  this  is  not  true  of  babies, 
delicate  persons,  invalids  and  those  whose  resistance  to 
disease  is  low.  The  strong  and  vigorous  do  not  truly 
escape ;  their  resistance  to  disease,  like  that  of  more 
delicate  persons,  varies  from  time  to  time,  and  when 
it  is  low  the  use  of  bad  milk  is  very  apt  to  cause  real 
sickness.     The  truth  of  this  was  convincingly  illus- 

(28) 


SAFE    MILK    AND    CREAM 

trated  at  a  large  military  school,  in  which  no  one  is 
accepted  as  a  student  without  passing  a  rigid  exami- 
nation for  physical  soundness.  A  change  in  the  milk 
used  at  the  school  from  ordinary  market  milk  to  milk 
produced  under  strict,  sanitary  supervision,  at  once 
greatly  reduced  the  time  lost  by  the  students  through 
sickness.  If  exceptionally  vigorous,  healthy  students, 
of  an  age  when  resistance  to  disease  is  greatest,  and 
who,  as  in  the  cas.:^  here  refer:  ed  to,  live  regular, 
normal  lives  and  are  guarded  against  indulgence  in 
weakening  and  injurious  habits  and  practices,  can 
have  the  amount  of  sickness  they  suffer  increased  or 
diminished  by  the  quality  of  the  milk  they  use,  we  are 
forced  to  conclude  that  no  person  can  aflford  to  risk 
the  exposure  of  his  or  her  health  to  bad  milk.  The 
available  evidence  truly  proves  that  those  who,  seem- 
ingly, are  not  harmed  by  bad  milk  would  be  more 
efficient  if  they  used  only  good  milk,  and  that  those 
whose  health  is  impaired  reduce  their  chances  for  re- 
covery when  they  use  bad  milk. 

And  now  wt  must  give  our  attention  to  the  dan- 
gers often  hidden  in  milk  which  cannot  be  sufficiently 
controlled  by  care,  cleanliness  and  watchfulness,  and 
which  must,  therefore,  be  fought  with  corrective, 
as  distinct  from  preventive,  measures. 

In  the  sense  that  the  more  serious  dangers  often 
hidden  in  milk  may  be  spoken  of  collectively  by  using 
one  word,  "bacteria,"  the  greatest  of  all  dangers  that 
menace  health  through  milk  may  be  defined  by  the 
term,  ''disease  germs." 

(29) 


WASHINGTON    HEALTH    RULES 

The  difference  between  the  three  classes  of  bacteria, 
the  harmless,  those  harmful  in  large  numbers  and  the 
true  disease  germs,  is  parallel  to  the  difTerenoe  be- 
tween three  substances,  for  example,  like  sugar,  alco- 
hol and  arsenic.  Sugar  is  harmless,  though  we  can 
make  ourselves  decidedly  uncomfortable  by  eating 
too  much  of  it.  Alcohol  is  widely  used  with  too  little 
thought  that  it  is  a  real  poison,  although  most  of  us 
know  that  it  is  best  to  avoid  it  and  that  its  excessive 
use  causes  all  manner  of  suffering.  And  arsenic  is 
a  poison  about  the  dangerous  character  of  which  no 
reasonable  person  is  uncertain. 

Various  facts  we  should  know  about  disease  germs 
in  milk  are  as  follows :  • 

1 .  True  disease  germs,  like  those  which  cause  tuber- 

culosis, typhoid  fever,  diphtheria,  scarlet  fever, 
infectious  sore  throat,  infantile  diarrhoea,  etc., 
may  be  fatally  numerous  in  milk  without 
changing  its  taste,  odor  or  appearance. 

2.  True   disease   germs   occur   in  milk   so   frequently 

that  thousands  of  cases  of  tuberculosis  and  hun- 
dreds of  epidemics  of  other  diseases  have  been 
traced  directly  to  infected  milk.  The  suffering, 
the  loss  of  time  and  money,  the  reduction  in 
human  efficiency  and  the  number  of  deaths 
caused  by  the  use  of  raw,  infected  milk  are  pre- 
ventable levils  which  no  one  acquainted  with 
their  magnitude  can  contemplate  without  horror. 

(30) 


SAFE    MILK    AND    CREAM 

3 .  Fatally  serious  epidemics  have  been  traced  directly 

to  milk  produced  and  distributed  by  dairies 
widely  recognized  as  models  of  perfection.  Milk 
can  be  kept  free  from  dirt  and  too  many  ordinary 
bacteria,  but  we  lack  the  knowledge  required 
certainly  to  exclude  true  disease  germs  from  it. 

4.  Persons    and    animals,    from    whose    bodies    dis- 

ease germs  are  expelled  in  a  way  that  leads 
to  the  infection  of  milk  when  such  persons  are 
engaged  in  dairy  work  or  such  animals  are 
members  of  dairy  herds,  may  be  considered  as 
belonging  to  several  groups,  as   follows : 

a.  Those  who  show  recognizable  symptoms  of  in- 
fectious diseases.  To  safeguard  milk  against 
infection  through  such  persons  and  animals  is 
possible. 

h.  Those  who  are  in  the  early,  so-called  incu- 
bative stages  of  infectious  diseases,  or  the 
stages  which  precede  the  development  of 
symptoms.  To  safeguard  milk  against  infec- 
tion through  such  persons  and  animals  is  ab- 
solutely impossible. 

c.  Those  who  are  apparently  healthy  but  ac- 
tually and  often  actively  affected  with  infec- 
tious diseases.  To  some  extent  milk  is  being 
safeguarded  against  infection  scattered  by 
such  persons  and  animals,  but  its  protection 
is,  and  will  long  remain,  wholly  inadequate. 

(31) 


WASHINGTON    HEALTH    RULES 

d.  Those  whO'  suffer  mild  attacks  of  infectious 
diseases  which  are  passed  over  as  unimpor- 
tant, simple  ihness  or  inconsequential,  little  in- 
dispositions. It  is  impossible  to  prevent  the 
infection  of  milk  through  such  persons  and 
animals. 

e.  Those    who    have    recovered    from    infectious 

diseases  but  continue  to  harbor  disease  germs 
in  their  bodies.  Thousands  of  cases  of  disease, 
with  many  deaths,  have  been  traced  directly 
to  milk  contaminated  by  such  persons. 

/.  Those  who  escape  infectious  diseases  because 
of  their  high  resistance  to  them  but  whose 
bodies  are  invaded  by  disease  germs.  Per- 
sons and  animals  of  this  class  are  very  numer- 
ous; it  is  impossible  to  prevent  the  infec- 
tion of  milk  with  germs  that  multiply  in  and 
are  expelled  from  their  bodies. 

g.  Persons  who  carry  disease  germs  on  their 
hands,  clothing,  etc.,  because  they  have  been 
in  contact  with  sick  relatives  and  friends. 
Infectious  diseases  among  the  relatives  and 
associates  of  dairymen  and  dairy  employees 
have  been  revealed  through  the  diseases  and 
deaths  caused  by  infected  milk. 

5.  By  far  the  greater  number  of  disease  germs  ex- 
pelled from  the  bodies  of  persons  and  animals 
die  or  lose  their  virulence  before  they  can  reach 

(32) 


SAFE    MILK    AND    CREAM 

the  bodies  of  new  victims,  and  most  healthy  per- 
sons have  enough  resistance  against  disease  to 
escape  harm  from  the  penetration  of  only  a  small 
number  of  disease  germs  into  their  bodies.  Even 
guinea  pigs,  which  are  among  the  most  suscep- 
tible of  all  animals  to  tuberculosis,  escape  with- 
out harm  when  they  are  exposed  to  not  more 
than  a  score  or  two  of  tuberculosis  germs.  If 
this  was  not  the  case  disease  germs  would  have 
depopulated  the  world  long  ago. 

6.  Disease  germs  on  the  floors  and  walls  of  houses, 

on  tables  and  chairs,  in  floor  coverings,  books, 
wearing  apparel,  etc.,  have  a  location  which  does 
not  insure  their  introduction  into  our  bodies ; 
they  menace  us ;  too  often  harm  us ;  but,  on  the 
Vv'hole,  they  are  only  on  their  way  to  our  bodies 
by  a  path  that  more  commonly  ends  elsewhere. 
And  remember,  they  do  not  multiply  on  the 
way.  Disease  germs  in  dust  and  air  are  so  in- 
tensely exposed  to  the  sterilizing  effects  of  light 
that  it  is  only  in  dust  from  rooms  occupied,  or 
recently  occupied  by  diseased  individuals,  and  in 
the  air  in  the  close  vicinity  of  such  diseased  per- 
sons that  the  presence  of  bacteria  is  to  be 
feared.  How  dust  and  bad  air  injure  health  is 
defined  in  another  chapter. 

7.  In  milk,   on   the  other  hand,   many   kinds  of  dis- 

ease germs  multiply ;  the  few  that  may  not  harm 
vigorous,  healthy  persons  become  the  many  that 

(33) 


WASHINGTON    HEALTH    RULES 

break  down  normal  resistance  to  disease,  and 
often  the  very  many  that  break  down  extra- 
normal  resistance,  and  in  the  place  of  being  on 
a  path  that  is  more  likely  to  end  elsew^iere  than 
in  our  bodies,  they  are  located  in  a  vehicle  that 
compares  favorably  with  an  express  train  that 
is   certain   to   reach   its   destination. 

8.  The  presence  of  disease  germs  in  milk,  if  the 
milk  is  obtained  from  apparently  healthy  animals 
under  good  sanitary  conditions,  and  is  other- 
wise clean  ;and  fresh,  can  be  deprived  of  its 
importance  and  danger  by  the  use  of  one,  simple, 
inexpensive  expedient.  The  expedient  is  pasteur- 
ization. 

To  pasteurize  milk  means  to  heat  it  to  a  degree  of 
temperature  not  high  enough  to  change  its  taste  or 
affect  its  quality  as  food,  for  a  sufficient  length  of 
time  to  kill  disease  germs. 

Among  the  various  disease  germs  that  seriously 
menace  us  through  milk,  tuberculosis  germs  can  bear 
exposure  to  heat  longer  than  other  kinds,  and  they 
are  killed  in  milk  by  heating  it  to  140°  P.,  for  20 
minutes.  At  a  somewhat  higher  temperature  they 
are  killed  in  less  time.  Hence,  if  milk  is  heated  to 
140°  F.,  for  20  minutes  or  longer,  all  the  true  disease 
germs  it  is  likely  to  contain  are  made  harmless. 

Much  milk  is  pasteurized  before  it  is  sold,  but  this 
should  not  be  accepted  as  safe  until  we  have  informed 
ourselves  through  careful  inquiry  that  it  is  properly 

(34) 


SAFE    MILK    AND    CREAM 

pasteurized  by  a  reliable  dealer.  No  supervision  over 
commercial  pasteurization,  or  pasteurization  by  dairy- 
men, exists  in  the  District  of  Columbia,  and  tests  of 
commercially  pasteurized  milk  have  shown  that  it  oc- 
casionally contains  virulent  disease  germs.  Until  com_ 
mercial  pasteurization  is  guarded  by  official  supervis- 
ion, unless  pasteurized  milk  can  be  obtained  from  a 
reliable  dealer,  the  proper  thing  to  do  is  to  buy  the 
best  obtainable  raw  milk  and  to  pasteurize  it  at  home. 
If  it  is  too  much  trouble  to  use  a  thermometer  to 
measure  the  degree  of  heat,  or  a  clock  or  watch  to 
measure  the  length  of  time  during  which  heat  is  ap- 
plied in  pasteurization ;  that  is  to  say,  if  proper  pasteur- 
ization at  home  is  too  burdensome,  milk  can  be  made 
safe  by  simply  scalding  it,  or  bringing  it  to  nearly 
the  boiling  point.  After  pasteurizing  or  scalding  milk 
it  should  be  cooled  and  kept  cold  and  covered  until  it 
is  used. 

Those  who  are  properly  informed  about  bacteria, 
particularly  true  disease  genus,  aud  their  occurrence 
in  milk,  and  who  know  that  health  is  a  possession 
of  incalctdable  value,  ivill  not  permit  a  drop  of  raw 
milk  to  pass  their  lips. 

As  all  dairy  products  derived  from  infected  milk 
are  unsafe  it  is  necessary,  before  concluding  the  chap- 
ter, to  say  a  few  words  about  cream,  ice  cream,  butter 
and  cheese. 

Raw  cream,  either  in  the  form  of  cream  or  ice 
cream,  is  as  dangerous  as  raw  milk.  Cold  does  not 
destroy  disease  germs ;  it  only  checks  their  niultipli- 

(35) 


WASHINGTON    HEALTH    RULES 

cation.  Food  is  not  kept  cold  to  improve  it  but  simply 
to  prevent  it  from  spoiling  and  becoming  unwhole- 
some through  the  multiplication  of  bacteria  in  it. 
Bacteria,  disease  germs  included,  remain  alive  after 
long  exposure  to  a  lower  temperature  than  the  lowest 
obtainable  in  an  ice-cream  freezer. 

Butter  and  chieese  have  not  been  proved  to  be  im- 
portant agents,  like  raw  milk  and  raw  cream,  through 
which  diseases  attack  us.  We  know,  positively, 
through  laboratory  tests,  that  a  considerable  propor- 
tion of  the  butter  and  cheese  sold  by  dealers  is 
contaminated  with  disease  germs,  but  whether  the 
germs  are  sufficiently  numerous  or  virulent  to  consti- 
tute a  serious  menace  to  health  remains  questionable. 
It  is  not  the  object  of  this  chapter  to  inspire  unreason- 
able fears  or  to  give  possible  and  probable  dangers 
unwarranted  importance.  About  raw  milk  and  cream 
we  know  that  the  dangers  to  which  laboratory  tests 
first  called  attention  have  been  proved  to  be  real  and 
fatally  serious.  The  evidence  is  abundant,  practical, 
direct  and  irrefutable. 

In  addition  to  pasteurizing  all  milk  at  home  for 
the  present,  or  restricting  ourselves  to  the  use  of  milk 
pasteurized  by  a  reliable  dairyman,  we  should  strive 
for  laws  requiring  the  pasteurization,  under  compe- 
tent official  supervision,  of  the  entire  milk  supply. 

A  controversy  has  long  raged  concerning  the  relative 
food  value  and  digestibility  of  raw  and  heated  milk, 
in  which  the  hygienists  have  taken  one  and  many 
physicians  the  other  side.     To  some  extent  this  con- 

(36) 


SAFE    IMILK    AND    CREAM 

troversy  remains  active,  with  the  hygienists  and  an 
increasing  number  of  physicians,  opposed  to  the  use 
of  milk  in  its  raw  state  on  one  side,  and  a  decreas- 
ing number  of  physicians,  who  continue  to  oppose  the 
use  of  heat  to  make  milk  safe,  on  the  other. 

No  one  now  seriously  claims  that  raw  milk  is  one 
iota  better  than  pasteurized,  scalded  oi  boiled  milk 
when  it  is  used  as  a  food  by  persons  older  than  un- 
weaned  infants,  and  the  available  data  prove  that 
pasteurized  cow's  milk  is  a  safer,  a  better  and  a 
generally  more  wholesome  food  for  unweaned  in- 
fants than  raw  cow's  milk. 

ERNEST    C.    SCHROEDER 


(37) 


SLEEP 
HEALTH  RULE  V 

Get  enough  sleep. 

Sleep   with  windows    open  or,  better    still, 
outdoors. 

The  health  rules  of  the  Association  for  the  Preven- 
tion of  Tuberculosis  are  particularly  designed  to  be  of 
use  to  the  pupils  of  our  public  schools.  The  boys  and 
girls  of  any  city  are  its  chief  asset  and  pride.  Sound 
minds  and  sound  bodies  go  hand  in  hand.  "Get  Plenty 
of  Sleep"  is  a  wholesome  maxim.  Sleep  is  a  require- 
ment,— not  an  elective  in  nature's  curriculum.  The 
new  born  infant  needs  to  sleep  twenty  hours  out  of 
every  twenty-four.  The  amount  required  gradually 
grows  less  until  at  two  years  of  age,  fifteen  hours  may 
be  sufficient.  With  growing  boys  and  girls  a  gener- 
ous amount  of  sleep  is  still  necessary.  The  rapid  body 
growth  of  children  between  the  ages  of  ten  and  six- 
teen makes  heavy  demands  upon  their  nervous  and 
physical  resources.  This  drain  can  be  met  in  part  by 
regular  habits  of  sleep  for  at  least  eight  hours  a  day. 
Nine  and  ten  hours  are  even  better  for  the  average 
boy  or  girl,  and  ndt  a  few  grown-ups  require  as 
much. 

What  is  known  as  fatigue  is  caused  by  the  genera- 
tion of  certain  waste  products  in  the  body — due  to 
mental  and  physical  exercise.     These  products  must 


SLEEP 

be  eliminated.  During  the  hours  of  sleep  when  the 
heart  action  slows  down  and  the  ordinary  mental  and 
physical  activities  are  at  rest,  the  production  of  these 
wastes  is  greatly  diminished  while  their  elimination 
continues.  These  wastes,  if  not  thrown  off,  play 
havoc  with  the  nervous  system — producing  restless- 
ness and  irritability,  which,  if  not  checked,  are  hable 
to  bring  about  a  nervous  or  mental  collapse. 

Insomnia,  or  the  inability  to  sleep,  is  nature's  danger 
signal  to  slow  down!  If  the  warning  is  unheeded, 
health  is  liable  to  be  wrecked  and  the  mind  become 
affected. 

One  of  the  evils  of  overcrowded  living  conditions 
among  the  poorest  of  our  people  is  the  lack  of  privacy 
for  quiet  sleeping.  Cooking,  eating,  living,  working 
and  sleeping  go  on  in  two  or  three  rooms.  The  effect 
on  the  children  of  the  family  is  liable  to  be  bad.  One's 
rules  for  sleep  should  be  plenty  of  it — ^taken  at  regular 
intervals — in  privacy  when  possible,  and  with  windows 
open,  or  better  still,  out  of  doors. 

This  brings  us  to  the  second  part  of  the  Health 
Rule  under  consideration. 

We  have  spoken  of  fatigue  as  occasioned  by  cer- 
tain waste  products  due  to  physical  and  mental  exer- 
cise. These  wastes  must  be  eliminated.  In  addition 
to  the  rest  and  sleep  required  for  their  elimination, 
plenty  of  oxygen  must  be  taken  into  the  lungs,  in 
order  to  burn  up  certain  of  these  products.  The 
effect  of  oxygen  upon  body  wastes  is  best  seen  when 
the  wastes  are  in  such  excessive  amounts  as  to  en- 

(39) 


WASHINGTON    HEALTH    RULES 

danger  the  life  of  the  sufiferer.  Thus  a  chief  feature 
of  the  modern  treatment  of  nervous  prostration,  pneu- 
monia and  tuberculosis,  as  well  as  other  diseases,  is  a 
plentiful  supply  of  fresh  air  or  oxygen.  As  a  cur- 
rent of  air  is  necessary  to  fan  the  spark  into  a  flame 
in  order  to  consume  household  waste,  so  oxygen  is 
an  essential  for  the  combustion  of  wastes  generated 
within  the  human  body. 

The  advantages  of  outdoor  sleeping  are  many.  First, 
one  is  assured  of  breaithing  fresh  or  unused  air.  Indi- 
vidual air  is  quite  as  desirable  as  individual  towels, 
individual  combs,  individual  tooth  brushes  and  indi- 
vidual drinking  cups.  The  old  prejudice  against  "out 
of  door  air"  at  night  is  now  known  to  be  groundless. 
Night  air,  especially  in  our  cities,  is  freer  from  dust 
and  smoke  and  gases  than  day  air.  During  the 
mosquito  season,  the  sleeper  should  be  protected  by 
screens  or  netting. 

Let  us  have  the  best  night  air  possible.  Most 
houses  and  many  apartments  now  being  erected  in 
this  climate  are  provided  with  porches.  Watch  the 
newspaper  "ads"  of  new  houses  and  observe  how 
sleeping  porches  are  featured  in  these  advertisements. 
Unfortunately,  there  is  still  a  prejudice  against  out- 
door sleeping.  Many  persons  dread  the  exposure. 
With  plenty  of  bedding,  one  need  have  no  fear  of 
catching  cold.  The  cold  complained  of  by  many  who 
have  tried  sleeping  out  of  doors  in  winter  is  due  not  to 
lack  of  covering,  but  to  lack  of  protection  from  the 
cold  that  penetrates  through  the  mattress.    Additional 

(40) 


SLEEP 

protection  may  be  obtained  by  the  simple  device  of 
placing  a  heavy  woolen  blanket  or  a  comfort  made  of 
padded  newspapers  between  the  spring  and  the  mat- 
tress. An  advantage  of  outdoor  sleeping  in  cold 
weather  as  compared  with  sleeping  in  a  room  with 
windows  open  is  that  one  may  come  into  a  warm  room 
to  dress  where  the  air  is  fresh  and  imbreathed. 

Another  advantage  of  outdoor  sleeping  in  winter  is 
the  tonic  effect  of  the  cold  air.  There  is  more  oxygen 
in  a  cubic  foot  of  air  at  freezing  point  than  there  is  at 
blood  temperature.  This  increased  oxygen  burns  up 
body  waste  and  the  products  of  fatigue  more  rapidly. 
Circulation  is  stimulated — digestion  is  stimulated — and 
one  awakens  refreshed  and  ready  for  the  day's  work. 
The  mental  stimulus,  for  example,  of  fresh  air  school 
rooms,  as  contrasted  with  poorly  ventilated  school 
rooms,  has  been  demonstrated  again  and  again. 

No  one  who  has  ever  camped  out  will  deny  the 
benefit  he  has  derived  from  life  in  the  open.  Why 
not  get  the  benefit  of  outdoor  living  the  year  around 
by  sleeping  out  of  doors  or  if  this  is  not  possible,  at 
an  open  window  or  as  near  the  open  window  as 
may  be. 

Moving  air  is  a  better  tonic  than  still  air.  Moving 
air  is  most  readily  obtained  out  of  doors.  Anyone 
may  try  the  experiment  of  opening  the  windows  and 
watching  the  effect  of  air  currents  upon  movable  ob- 
jects within  the  room,  like  draperies  or  curtains.  The 
agitation  is  in  the  inverse  ratio  of  distance  from  the 
window. 

(41) 


WASHINGTON    HEADTH    RULES 

Practical  experience  has  demonstrated  that  living  In 
the  open  air  is  one  of  the  important  means  whereby 
anaemic  persons,  nervous  invalids  or  sufferers  from 
lung  'trouble  may  regain  their  health.  Such  persons 
gain  in  weight,  and  pallor  gives  place  to  rosy  cheeks, 
indicative  of  improved  circulation.  By  sleeping  out  of 
doors,  any  one  whatever  his  occupation,  may  spend  at 
least  one-third  of  his  time  in  the  open  air.  A  gain  of 
weight  and  health  in  the  case  of  persons  below  nor- 
mal is  almost  sure  to  follow,  while  resistance  to  nose, 
throat  and  lung  troubles,  as  well  as  other  diseases  is 
increased. 

WALTER  S.  UFFORD 


v'42) 


KEEP  CLEAN 
HEALTH  RULE  VI 

Take  a  bath  or  sponge  daily,  and  a  warm 
bath,  followed  by  a  cold  splash,  plunge,  or 
shower,  once  or  twice  a  week  or  oftener. 

Use  soap  freely. 

Wash  your  hands  before  handling  food. 

Don't  put  fingers,  money,  paper,  or  pencils 
in  your  mouth. 

Don't  bite  your  fingernails. 

Cleanliness  is  a  virtue  which  is  not  inherent  in 
human  kind  and  must  therefore  be  taught,  by  pre- 
cept, and  example,  like  other  virtues.  When  cleanli- 
ness is  not  an  acquired  habit  it  may  even  be  a  much 
objected  to  nuisance.  We  find  this  in  particular  the 
case  with  youthful  humanity;  the  fact  is  that  every 
healthy  child  is  a  savage,  who  craves  playing  with 
dirt,  enjoys  digging  ditches  and  shoveling  hills,  and 
delights  in  those  rare  privileges  of  youth,  the  mak- 
ing of  mud  pies  and  the  wading  in  a  flowing  gutter, 
shoes  off  or  on  doesn't  matter. 

To  show  that  cleanliness  is  an  acquired  element  of 
civilization  we  need  only  to  behold  what  an  acute 
punishment  a  scrub  or  a  tub  bath  is  to  the  average  boy. 
Nay,  there  exist  whole  nations  who  honestly  think 
that  frequent  bathing  is  not  a  social  duty  and  who 
defend  themselves  by  the  specious  argument  that  you 

(43) 


WASHINGTON    HEALTH    RULES 

can  reach  a  hale  old  age  even  though  you  reduce 
washing  the  body  to  the  minimum  and  that  it  is  not 
natural  for  human  kind  to  wash,  except,  maybe,  the 
uncovered  portion  of  the  body,  the  face  and  hands. 
And  there  is  not  the  least  doubt  but  that  one  might 
go  through  a  long  life  under  a  regime  of  cleanlessness, 
provided  only  that  one  selected  healthy  and  contented 
parents  and  thereby  acquired  without  effort  such  a 
robust  constitution  as  would  permit  all  kinds  of  tres- 
passes against  hygiene  with  impunity.  In  fact,  if  every- 
body inherited  this  naturally  high  resistance  to  the 
ills  of  flesh  there  would  be  scant  use  for  Health  Rules, 
though  it  would  probably  be  found  that  even  a  Roose- 
velt can  withstand  greater  hardships  and  lead  a  more 
strenuous  life  because  he  adds  to  a  rare  native  ruddi- 
ness the  fortifying  elements  of  hygienic  living. 

Yet  there  have  been  many  men  of  genius  who  were 
oblivious  to  the  care  of  the  body,  but  we  may  as- 
sume that  their  lives  would  have  been  greater,  of 
longer  duration  and  more  perfect  had  they  harbored 
their  transcendent  souls  in  what  the  human  body  is 
when  at  its  best,  a  temple  of  nature,  born  to  charm 
and  beauty,  and  which  can  be  kept  perfect  under  the 
benign  and  illuminating  rays  that  are  shed  by  the 
precepts  of  an  advancing  civilization. 

When  the  spiritual  ideals  that  arose  in  Palestine 
are  linked  to  the  religion  of  the  body  such  as  pre- 
vailed in  ancient  Greece,  then  may  we  behold  those 
highest  types  of  manhood  and  womanhood  which  the 
human  race  is   capable  of   producing  and  which,   in 

(44) 


KEEP   CLEAN 

an  encouraging-  way,  it  does  bring  forth  in  ever  in- 
creasing numbers.  Clean  persons  are  healthier  and 
more  efficient  as  a  rule  than  dirty  persons,  and  vastly 
more  attractive. 

Cleanliness  became  easier  of  accomplishment  when 
soap  was  invented.  The  mixing  of  oil  or  fat  with  an 
alkali,  the  latter,  as  a  rule,  slightly  in  excess,  pro- 
duces ordinary  soap.  It  may  be  scented  by  perfumes 
and  colored  by  dyes  and  all  animal  fats  or  vegetable 
oils  lend  themselves  to  the  making  of  soap;  even  the 
so-called  fatty  acids  contained  in  resins,  gums  or  waxes 
may  yield  soap  when  mixed  with  a  proper  alkali. 

When  soap  is  dissolved  in  water  it  forms  suds  or 
lather,  and  the  alkali  which  is  thereby  set  free  may 
then  be  used  for  making  further  soap  by  combining 
it  through  rubbing  with  the  fatty  film  which  at  all 
times  covers  the  human  body.  It  would  be  difficult 
to  remove  this  film  by  water  alone  but  when  it  is  first 
transformed  into  soap,  it  can  readily  be  washed  off 
in  water.  We  could  use  the  alkali  alone  for  washing 
ourselves,  but  we  would  often  use  too  much  of  it 
and  the  advantage  of  good  soap  is  that  it  is  made  with 
such  a  slight  and  definite  surplus  of  alkali  as  will 
not  injure  the  skin  and  draw  out  of  vt  too  much  of 
its  natural  fat.  The  skin  would  often  be  left  too  dry 
for  comfort  were  we  to  wash  ourselves  with  the  alkali 
alone. 

The  hygienic  value  of  washing  with  soap  is  obvious. 
In  removing  the  fatty  film  which  covers  our  skin, 
and  which  is  constantly  developed  by  it,  we  remove 

(45) 


WASHINGTON    HEALTH    RULES 

with  it  the  dirt,  dust  and  bacteria  which  have  stuck 
to  it.  After  washing,  the  skin  remains  clean  for  a 
while;  then  more  fat  and  perspiration  exude  from 
the  body,  more  dirt,  dust  and  bacteria  stick  to  it  and 
washing  becomes  again  necessary.  When  once  people 
have  acquired  the  habit  of  frequent  washing  and  bath- 
ing they  will  feel  uncomfortable  and  guilty  of  neglect 
if  circumstances  prevent  them  from  indulging  in  the 
blessed  practice.  In  particular  do  our  hands  require 
frequent  washing  with  soap  because  we  handle  with 
them  all  kinds  of  objects  covered  by  dust,  dirt  and  bac- 
teria and  much  sickness  is  caused  by  direct  or  indi- 
rect contact  between  people  some  of  whom  may  be 
indifferent  to  cleanliness.  Some  of  these  may  belong 
to  the  so-called  disease  carriers  because  having  been 
sick  with  an  infectious  disease  they  continue  to  elimi- 
nate the  germs  of  that  disease,  and  it  is  fairly  proved 
that  a  certain  percentage  of  such  people  remain  car- 
riers for  a  lesser  or  longer  period.  Washing  our  hands 
before  handling  food  is  therefore  desirable  both  from 
the  esthetic  sense  and  out  of  hygienic  consideration. 
For  thousands  of  years  washing  the  hands  before  eat- 
ing was  a  religious  duty  among  Jews  and  it  was  ac- 
companied by  a  special  form  of  a  blessing.  And  this 
enforced  habit  undoubtedly  added  to  the  wellknown 
vitality  of  that  ancient  people.  Among  the  old  Romans 
and  Greeks  bathing  was  a  cult  which  was  encouraged 
by  the  government.  Visitors  to  Rome  stand  in  wonder 
when  they  behold  the  ruins  of  what  were  once  the 
Baths  of  Caracalla  which  could  accommodate   many 

(46) 


KEEP   CLEAN 

thousands  of  people  at  one  time.  Cold,  tepid  and  hot 
baths  were  provided  and  their  use  was  undoubtedly 
free  for  all  the  people. 

But  it  is  with  cleanliness  as  with  other  hygienic  in- 
junctions. We  may  often  disregard  them  and  escape 
punishment,  but  we  never  know  when  we  may  have 
become  susceptible  and  sensitive  to  infection,  when 
overwork,  loss  of  sleep,  improper  food,  worry  or  in- 
tentional neglect  may  have  broken  down  our  vitality 
or  our  natural  resistance  to  disease.  When  this  hap- 
pens to  be  the  case,  a  single  mouthful  of  food  which 
was  handled  by  soiled  fingers  may  convey  enough 
virulent  disease  germs  to  our  mouth  to  throw  us  on 
the  sickbed  for  weeks,  often  forcing  us  to  fight  for 
our  very  life  with  the  last  shred  of  an  impaired  vitality. 
Putting  money,  paper  or  pencils  into  our  mouth  is 
likewise  to  be  censured  because  it  is  clear  and  has  often 
been  proved  that  they  may  convey  infectious  diseases 
after  having  been  handled  by  a  number  of  people. 
For  this  reason  also  should  kissing  children  on  the 
mouth  never  be  tolerated  because  children  are  in  par- 
ticular susceptible  to  infections  at  all  times  and  should 
be  shielded  against  disease  germs  conveyed  by  con- 
tact with  careless  or  even  wellmeaning  but  unsus- 
pected people. 

The  health  rule  which  is  covered  by  this  chapter 
recommends  that  a  warm  bath  should  be  followed  by  a 
cold  splash,  plunge  or  shower.  During  immersion 
in  hot  water  the  pores  of  the  skin  open  up  and  the 
temperature  of  the  skin  rises  to  the  temperature  of 

(47) 


WASHINGTON    HEALTH    RULES 

the  water,  or  higher  in  a  vapor  or  hot  air  bath.  This 
is  the  reason  why  the  native  Russian  or  Indian  emerg- 
ing from  a  steam  bath  can  enjoy  running  directly  out 
into  the  snow  and  rolHng  around  in  it,  finding  this  prac- 
tice both  exhilarating  and  healthful. 

The  skin  being  a  poor  conductor  of  heat  and  cold  it 
is  affected  by  the  snow  only  in  the  outer  layers  and 
there  is  enough  heat  stored  up  in  the  layers  beneath 
to  protect  the  interior  of  the  body  and  the  vital  organs, 
so  that  no  harm  can  come  to  them.  On  the  other 
hand  the  terminals  of  the  nerves  and  pores  through 
which  the  skin  acts  receive  a  wholesome  stimulation 
and  reaction  into  a  particularly  healthful  state  by  a 
species  of  temperature  massage  and  produce  a  remark- 
able glow  over  the  whole  body,  a  sensation  of  youth- 
fulness  and  vigor  not  easily  obtainable  by  other  means 
equally  harmless.  This  it  is  which  makes  a  cold  splash, 
plunge  or  shower  after  a  hot  bath  so  beneficial,  but 
when  persons  are  thin  of  body  and  not  covered  with 
plenty  of  tissue  they  may  find  a  sudden  change  of  tem- 
perature unpleasant  and  experience  a  shock.  For 
these  it  is  advisable  to  apply  the  cold  water  action 
gradually  but  ending  it  with  water  ranging  between 
50°  to  60°  F.  the  average  temperature  of  river  or 
hydrant  water. 

Rubbing  the  body  with  alcohol  after  a  hot  bath  is 
also  useful  for  the  purpose  of  hardening  the  skin 
against  sudden  changes  in  temperature. 

A  skin  so  treated  regularly  will  easily  tolerate  an 
occasional   cold   draft   or   the  exposure   to   inclement 

(48) 


KEEP   CLEAN 

weather ;  it  will  help  protect  its  owner  against  com- 
mon, so-called  colds,  which  often  result  from  breathing 
close  and  impure  air  or  that  laden  with  house  dust. 
Many  so-called  colds  are  due  to  germs  which  have 
lodged  and  proliferate  on  the  mucous  membranes  of 
nose,  mouth,  throat  and  larynx.  They  can  be  readily 
avoided  by  observing  the  instructions  laid  down  in 
Health  Rules  I  and  VI. 

Viewed  simply  as  a  protective  envelope,  the  skin 
is  highly  efficient.  It  is  tough  and  elastic,  and  thickest 
and  firmest  where  the  greatest  strength  is  required. 
When  it  is  sound  and  free  from  abrasions,  scratches, 
punctures,  cuts  and  other  wounds,  it  is  practically  im- 
pervious to  disease  germs.  When  it  is  clean,  the 
little  injuries  to  which  it  is  liable  generally  heal 
rapidly,  but  when  it  is  dirty  and  the  dirt  contains 
dangerous  bacteria,  which  is  often  the  case,  little  in- 
juries may  lead  to  evils  ranging  in  severity  from 
slight  festering  sores  to  severe  inflammations,  or  to  the 
development  of  abscesses,  ulcers,  and  even  blood  pois- 
oning. In  this  connection  we  should  bear  in  mind  that 
varieties  of  bacteria  exist  which  may  be  swallowed 
with  impunity  but  which  are  very  dangerous  when  they 
pass  under  our  skin  or  into  our  circulation  through 
a  wound.  Such  bacteria  are  so  common  that  it  is  fair 
to  assume  they  are  always  present  in  dirt. 

Biting  fingernails  is  a  habit  for  which  it  is  not  easy 
to  find  a  good  explanation.  It  begins  usually  before 
children  enter  school  among  such  as  are  of  a  restless 
or  apprehensive  disposition.     Early  attention  to  chil- 

(49) 


WASHINGTON    HEALTH    RULES 

dren  affected  with  the  habit  is  necessary  to  break  them 
of  it.  Keeping  their  nails  well  trimmed  down  at  all 
times  should  help  and  so  should  an  appeal  to  personal 
pride  by  holding  hands  with  bitten  fingernails  next  to 
such  that  are  not  bitten. 

Teaching,  enforcing  and  practicing  cleanliness  is 
a  duty  we  owe  society  for  the  same  reason  as  the 
teaching,  enforcing  and  practicing  of  other  virtues.  It 
certainly  will  have  its  own  reward,  in  better  health, 
in  a  wholesome  regard  and  respect  for  the  wonderful 
organism  of  the  human  body  and  in  raising  the 
esthetic  ideal  of  spotlessness  which  is  as  much  a  part 
of  pure  living  as  the  observance  of  strictly  moral 
codes  and  commandments. 

We  must  keep  clean  to  meet  the  requirements  of 
civilization ;  we  must  keep  clean  to  be  presentable  to 
refined  and  educated  persons ;  we  must  keep  cltan  to 
avoid  diseases,  notably  those  through  which  we  may 
become  a  menace  to  our  relatives,  friends,  associates 
and  the  community  in  which  we  live,  and  we  must  be 
clean  in  body  and  mind  to  truly  merit  the  rank  of 
American  citizens. 

EMILE   BERLINER 


(50) 


FOOD 
HEALTH  RULE  VII 

Don't    eat  food  that  has  been  exposed  to 
flies  or  dust,  or  touched  by  unclean  hands. 

Raw  fruits  or  vegetables  so  exposed  should 
be  rinsed  or  washed  thoroughly. 

Chew  your  food  well. 

The  influence  of  dust  upon  foodstuffs  is  determined 
primarily  by  three  factors :  First,  the  quantity  of  the 
dust.  Second,  the  composition  of  the  dust.  Third, 
the  nature  of  the  foodstuffs.  Three  factors  operate 
secondarily :  First,  time  after  the  exposure  of  the  food- 
stuff to  the  dust.  Second,  temperature.  Third,  hu- 
midity. These  secondary  factors  may  be  of  the  ut- 
most importance  in  determining  the  condition  of  the 
foodstuff  at  any  given  moment,  but  they  are  not  ger- 
mane to  the  purposes  of  this  paper. 

Quantity  of  dust.  The  quantity  of  dust  in  any  given 
place  is  determined  by  the  character  of  the  adjacent 
surfaces,  the  materials  upon  them,  the  disturbances  to 
which  such  surfaces  and  materials  are  subjected,  and 
the  extent  and  character  of  prevailing  air  currents. 

Composition  of  dust.  The  composition  of  the  dust 
found  in  any  place  depends  upon  the  materials  of 
which  adjacent  surfaces  are  composed  and  the  nature 
of  the  substances  deposited  upon  such  surfaces.  The 
ordinary  dust  of  the  street,  market,  store,  kitchen,  and 

(51) 


WASHINGTON    HEALTH    RULES 

dining  room  is  made  up  of  inorganic  matter,  which 
may  be  classed  roughly  under  the  popular  phrase, 
''mineral  matter";  dead  organic  matter,  possibly  better 
described  popularly  as  dead  animal  and  vegetable  mat- 
ter ;  and  living  microorganisms.* 

Classification  of  foodstuffs.  Variation  in  the  charac- 
ter of  foodstuffs,  and  resultant  variations  in  the  proc- 
esses to  v^hich  they  are  subjected  before  being  eaten, 
must  be  considered  in  determining  the  effect  of  ex- 
posure to  dust.  Food  may  permit  or  even  require  the 
entire  removal  of  the  outer  surface  before  it  is  eaten, 
as  in  the  case  of  fresh  fish,  crabs,  and  watermelons; 
or  such  treatment  may  be  impossible,  as  in  the  case  of 
lettuce  and  berries  of  all  kinds.  Food  may  always  be 
cooked  before  being  eaten  as  in  the  case  of  fresh  fish ; 
or  it  may  never  be  cooked,  as  in  the  case  of  lettuce. 
Food  may  be  easily  decomposable,  as  in  the  case  of 
shucked  oysters ;  or  it  may  decompose  only  under  the 
most  favorable  circumstances,  and  then  slowly,  as  in 
the  case  of  nuts.  Food  may  be  brought  to  the  market 
in  a  comparatively  clean  condition,  as  in  the  case  of 
bread ;  or  it  may  be  uniformly  and  necessarily  dirty, 
as  in  the  case  of  potatoes,  beets,  and  radishes.  Food 
may  have  been  fully  prepared  for  the  table  and  subject 
to  contamination  after  the  last  cleansing  and  cooking 
process  has  been  completed,  as  in  the  case  of  pies;  or 
it  may,  as  in  the  case  of  undrawn  poultry,  require 
each  and  every  cleansing  and  cooking  process  before 

*The  word  "microorganism"  is  used  in  preference  to  the  word  "bacteria,' 
since  it  covers  all  varieties  of  microscopic  life ;  for  instance,  molds. 

(52) 


FOOD 

it  can  be  eaten.  It  is  impossible  here  to  describe  the 
influence  of  all  such  circumstances,  and  of  varying 
combinations  of  them,  in  determining  the  effect  that 
exposure  to  dust  will  have  upon  individual  varieties 
of  foodstuffs.  It  is  manifest,  however,  that  no  hard 
and  fast  rule  can  be  laid  down  with  respect  to  the 
matter. 

Quantity  of  dust  in  its  relation  to  foodstuffs.  The 
presence  of  large  quantities  of  dust  upon  food  of  any 
kind  renders  it  undesirable  for  human  consumption, 
and  it  would  hardly  be  stretching  the  point  to  say  that 
dust  in  large  quantities  renders  food  actually  unwhole- 
some, even  without  reference  to  the  composition  of 
the  dust.  For  we  know  that  food  grossly  dusty — 
or  grossly  dirty,  and  that  amounts  to  the  same  thing — 
is  revolting  to  the  appetite ;  and  we  know  further  that 
if  the  appetite  revolts  at  any  food,  such  food  is  eaten 
with  less  relish  and  is  less  easily  digested.  If  the  dust 
has  not  affected  the  composition  of  the  food  and  can  be 
removed  without  injuring  it,  the  food  may  be  cleansed 
and  then  eaten  with  impunity,  at  least  if  the  tact  that 
it  was  dusty  or  dirty  be  not  known  to  the  consumer. 
But  if  the  character  of  the  food  be  such  as  to  pre- 
vent the  removal  of  the  dust  without  injury  to  the 
food,  or  if  the  dust  contain  ingredients  whose  bare 
presence  is  revolting  to  persons  of  ordinary  refine- 
ment, as  certain  excrementitious  matters,  then  the 
food  has  lost  permanently  something  of  its  whole- 
someness  and  soundness.  For  civilized  men  and 
women,  of  ordinary  refinement,  food  must  be  clean  or 

(53) 


WASHINGTON    HEALTH    RULES 

at  least  believed  to  be  clean,  or  else  it  lacks  something 
of  its  normal  relish  and  digestibility. 

Inorganic  dust  in  its  relation  to  foodstuffs.  The  in- 
organic or  mineral  matter  found  in  dust  consists  of 
minute  particles  ground  from  street  and  road  surfaces, 
and  other  like  matter.  Much  of  it  is  insoluble.  When 
deposited  upon  food  it  has  no  power  of  increasing  in 
quantity,  materially  changing  its  character,  or  by  com- 
bining with  the  food  to  give  rise  to  harmful  substances. 
In  so  far  as  this  particular  ingredient  of  dust  is  con- 
cerned, it  is  from  the  standpoint  of  food  practically 
harmless,  except  as  it  may  make  the  food  less  appe- 
tizing. 

Dead  organic  matter  in  dust,  in  relation  to  food- 
stuffs. The  dead  organic  matter  that  forms  one  of  the 
elements  of  which  dust  is  composed  is  made  up  of 
particles  of  leaves,  straw,  hay,  and  other  like  things, 
and  fine  particles  of  animal  matter  from  wool  carpets, 
the  surface  of  the  skin,  etc.  In  the  city,  no  inconsider- 
able part  of  this  material  comes  from  the  manure  that 
has  been  deposited  upon  the  street,  and,  which  has 
dried  and  been  pulverized  by  passing  feet  and  pass- 
ing vehicles.  Like  the  inorganic  matter,  it  has  no 
power  of  increasing  in  quantity ;  but  it  may  be  changed 
in  character  by  the  action  of  the  microorganisms  that 
the  dust  contains,  and  it  enables  such  microorganisms 
to  multiply.  In  itself,  such  dead  organic  matter  has 
no  injurious  influence  upon  the  health  of  the  person 
consuming  the   food  upon  which   it  happens   to   fall. 

(54) 


FOOD 

Its  presence,  however,  if  recognized,  tends  materially 
to  diminish  the  relish  with  which  the  food  is  eaten. 

Microorganisms  in  dust,  in  their  relation  to  food- 
stuffs. Microorganisms  are  invariably  present  in  the 
ordinary  dust  of  the  street,  market,  store,  kitchen, 
and  dining  room.  The  number  present  under  ordi- 
nary conditions  is,  however,  much  less  than  is  popu- 
larly supposed ;  and,  again  contrary  to  popular  belief, 
the  presence  of  disease  producing  germs  among  them 
is  not  frequent.  Varieties  that  tend  to  decompose 
foodstuffs  are  common.  From  a  public  health  stand- 
point, the  microorganisms  in  dust  are  the  most  im- 
portant element  in  it,  since  they  can  increase  in  num- 
ber after  they  have  been  deposited  upon  food  and  some 
of  them  even  after  they  have  been  swallowed,  and 
such  increase  causes  changes  in  the  food  and  possibly 
gives  rise  to  disease.  The  exact  nature  of  the  changes 
that  occur  depends  upon  the  nature  of  the  micro- 
organisms and  upon  the  nature  of  the  foodstuff's,  but 
concerning  the  exact  nature  of  the  changes  that  may 
be  expected  in  any  particular  case  it  is  difiBcult  and 
commonly  impossible  to  speak  in  advance,  owing  to 
our  ignorance  of  at  least  some  of  the  controlling 
factors. 

While  the  facts  that  any  given  article  of  food  must 
be  peeled  or  shelled,  or  the  outer  covering  other- 
wise discarded,  and  that  the  food  may  or  must  be 
washed  or  cooked  before  being  eaten,  have  an  im- 
portant bearing  upon  the  sanitary  relations  of  dust 
generally,  they  are  particularly  important  with  refer- 

(55) 


WASHINGTON    HEALTH    RULES 

ence  to  the  microorganisms  the  dust  contains.  In  the 
first  place,  the  natural  protective  coverings  of  vege- 
tables, fruits,  fish,  poultry,  and  game  limit  very  much 
the  ability  of  such  microorganisms  to  find  their  ways 
into  the  interior  of  such  foodstuffs ;  and  in  the  second 
place,  even  though  such  outer  coverings  be  not  re- 
moved before  or  at  the  time  the  food  is  eaten,  thus 
carrying  the  contaminating  microorganisms  with 
them,  they  render  possible  much  more  thorough  cleans- 
ing than  could  be  otherwise  effected. 

Ordinary  cooking  processes  may  be  relied  upon 
very  generally  to  destroy  such  microorganisms  as 
have  found  their  way  on  to  the  surfaces  of  foodstuffs 
as  an  incident  to  marketing  and  preparation  for  the 
table,  particularly  such  as  have  lodged  upon  the  sur- 
faces of  fruits  and  vegetables.  Unfortunately,  how- 
ever, in  some  cases  of  bacterial  contamination  of 
meats  and  fish,  cooking  fails  to  accomplish  this  result, 
and  serious  and  even  fatal  poisoning  ensues.  Such 
cases  were  formerly  designated  as  cases  of  "ptomaine 
poisoning,"  and  are  popularly  still  so  named;  but  as 
ptomaines,  so-called,  are  no  longer  believed  to  be 
the  active  factors,  the  name  is  a  misnomer,  and  such 
cases  are  now,  for  want  of  a  better  name,  called  simply 
cases  of  "food  poisoning." 

From  what  has  been  said,  it  is  manifest  that  the 
greatest  danger  that  arises  through  the  bacterial  co:- 
tamination  of  foodstuffs  is  that  which  occurs  through 
the  happening  of  such  contamination  in  the  kitchen 
or  the  dining  room ;  or  at  least  that  which  happen? 

(56) 


FOOD 

after  the  foodstuff  has  been  finally  prepared  for  the 
table,  as  in  the  case  of  bread,  cakes,  and  pies,  after 
they  have  been  taken  from  the  oven. 

Conclusions.  Dust  is  composed  of  inorganic  mat- 
ters, dead  organic  matter,  and  living  microorganismiS. 
If  it  is  present  on  foodstuffs  in  large  quantities 
it  may  offend  the  appetite  and  thus  interfere 
with  the  normal  consumption  and  digestion  of  the 
contaminated  food,  no  matter  what  the  composition 
of  the  dust  may  be.  Ordinarily,  however,  the  inor- 
ganic and  the  dead  organic  matter  may  be  regarded 
as  negligible  elements  in  the  composition  of  dust,  in 
so  far  as  relates  to  the  soundness  and  wholesomeness 
of  foodstuffs.  Such  danger  as  arises  is  commonly  due 
to  the  microorganisms  present.  These  may  act  by 
causing  the  foodstuff  to  undergo  decomposition,  thus 
rendering  it  less  palatable,  less  digestible,  and  possibly 
less  wholesome  or  even  positively  poisonous.  Micro- 
organisms from  dust  may  act  also  by  causing  specific 
diseases,  like  typhoid  fever,  when  the  contaminating 
microorganism  is  the  causative  agent  of  such  a  dis- 
ease ;  but  this  is  rarely  the  case.  Safety  lies  in  the  dis- 
carding of  the  outer  parts  of  all  foodstuffs  that  have 
been  exposed  to  contamination,  thorough  cleansing  and 
thorough  cooking;  but  when  these  safeguards  are  im- 
practicable, owing  to  the  nature  of  the  foodstuff,  the 
prevention  of  contamination  is  the  only  means  of 
safety.  Prevention  of  contamination  may,  moreover, 
well  supplement  peeling,  washing,  and  cooking,  so  as 
to  guard  against  any  possible  failure  in  their  appUr 

(57) 


WASHINGTON    HEALTH    RULES 

cation.  Reasonable  regulations  for  the  (protection 
of  foodstuffs  from  dust,  while  they  are  exposed  for 
sale,  are,  therefore,  justified.  Precautions  within  the 
household  are  essential. 

Contamination  of  Food  by  Flies. 

The  influence  of  flies  upon  foodstuffs  may  be  man- 
ifested directly  in  three  ways :  First,  the  fly  may 
"blow"  the  food — that  is,  deposit  its  eggs  upon  it. 
Second,  the  fly  may  deposit  microorganisms  that 
cause  decomposition.  Third,  the  fly  may  deposit 
microorganisms  that  cause  disease.  The  aesthetic 
relations  of  the  fly  to  food  can  not  be  ignored,  how- 
ever, at  the  present  time,  when  everyone  is  familiar 
with  the  filthy  habits  of  this  insect  and  the  mere  fact 
that  flies  have  been  on  food  tends  to  make  it  repulsive 
to  persons  of  ordinary  refinement. 

Fly-blozun  food.  The  influence  of  the  eggs  of  the 
fly  and  even  of  the  maggot  is  more  or  less  localized, 
and  the  limits  of  the  space  affected  may  be  easily 
determined.  Sometimes,  therefore,  the  affected  part 
of  flyblown  food  may  be  removed  and  the  rest  used. 
If,  however,  the  mass  of  the  food  involved  is  small, 
it  may  be  necessary  to  discard  it  in  its  entirety.  The 
objection  to  the  use  of  flyblown  meat  is  aesthetic, 
since  there  is  no  disease  that  can  be  attributed  to  the 
use  of  such  food.  As  has  been  stated  above,  however, 
food  that  is  repulsive  to  the  aesthetic  sense  and  to  the 
palate  is  eaten  with  less  relish  than  is  other  food,  and, 
according  to  modern  observations,  it  may,  therefore, 

(58) 


FOOD 

be  less  easily  digested  than  is  food  that  appeals  to  the 
appetite. 

Fly-home  microorganisms  in  their  relations  to 
food.  The  microorganisms  a  fly  deposits  upon  food 
stuffs  are  taken  up  by  the  fly  with  its  food  or  are 
simply  such  as  happen  to  adhere  to  the  feet,  legs,  and 
other  parts  of  the  fly's  body.  Microorganisms  taken 
up  with  the  fly's  food  may  pass  through  the  fly's  di- 
gestive tract  and  be  deposited  upon  foodstuffs  in  fly- 
specks.  Such  microorganisms  as  adhere  to  the  feet, 
legs,  and  other  parts  of  the  fly's  body  are  transferred 
by  mere  contact  to  the  foodstuffs  which  the  fly  touches. 
The  effect  of  such  microorganisms,  however  de- 
posited, will  depend  upon  the  variety,  and  upon  the 
nature  of  the  foodstuff.  A  fly  can  not,  however,  de- 
posit any  microorganism  that  will  cause  any  specific 
disease,  such  as  typhoid  fever,  unless  the  fly  has  first 
picked  up  the  germs  of  that  particular  disease,  and  out- 
side of  the  bacteriological  laboratory  these  are  always 
derived   from  a  patient  suffering  from  that   disease. 

The  idea  of  eating  fly-specked  food  is  itself  dis- 
gusting, since  fly-specks  are  the  filth  discharged  from 
the  fly's  body,  and  this  disgust  is  increased  by  a  knowl- 
edge of  the  fact  that  the  very  food  that  the  fly  takes 
into  its  stomach  is  so  often  filth  of  the  nastiest  kind. 
The  fly's  habit  of  feasting  on  such  filth  is  responsible, 
too,  for  the  spread  of  disease  through  the  fly,  since 
it  is  by  visits  to  all  kinds  of  discharges  from  the  bodies 
of  human  beings  that  the  fly  gets  the  disease  germs 
that  it  carries.     A  fly  that  has   feasted  on  the  dis- 

(59) 


WASHINGTON    HEALTH    RULES 

charges  from  a  patient  suffering  from  typhoid-fever, 
and  possibly  on  the  discharges  of  patients  suffering 
from  other  communicable  diseases,  or  which  has 
dragged  itself  over  such  filth,  may  convey  the  disease 
by  which  it  has  been  contaminated. 

It  is  impossible  to  distinguish  flies  that  are  danger- 
ous by  reason  of  having  been  in  contact  with  such 
dangerous  filth,  from  flies  that  have  not  been  so 
fouled.  For  this  reason,  and  because  of  the  nastiness 
of  the  habits  of  all  flies  and  the  physical  discomfort 
that  they  cause,  there  is  only  one  safe  rule  to  follow : 
Exterminate  the  fly.  And  until  the  fly  has 
been  exterminated,  endeavor  by  strictest  cleanliness 
to  render  the  home,  the  restaurant,  and  other  places 
where  foods  are  kept,  uninviting  to  the  fly  and  keep 
out  by  careful  screening  such  flies  as  attempt  entrance. 

Food  and  Unclean  Hands. 

Human  hands  constitute  the  greatest  source  of 
danger  in  relation  to  the  spread  of  disease  through 
food  other  than  milk.  Hands  come  into  contact  with 
so  many  things  and  are  called  upon  necessarily  to 
perform  so  many  duties  with  respect  to  the  daily 
toilet  of  each  person  that  they  are  exposed  on  many 
occasions  to  contamination  by  the  germs  of  disease — 
of  typhoid  fever,  tuberculosis,  diphtheria,  and  so  on. 
These  germs  may  remain  on  the  infected  hand  for 
considerable  periods  of  time,  and  then  pass  from  the 
hand  to  food  that  is  about  to  be  eaten.  If  the  food 
contaminated  by  such  hands  is  not  at  the  time  in  a 

(60) 


FOOD 

state  that  requires  some  subsequent  cleaning  or  cook- 
ing process  that  will  effectually  sterilize  it,  disease  may 
result.  In  view  of  the  fact  that  much  of  our  food  is 
necessarily  handled  by  persons  engaged  in  serving  it, 
even  after  having  been  cooked,  and  much  of  it  comes 
into  contact  with  the  hands  of  the  consumer  when  he 
eats  it,  there  remain  many  opportunities  for  the  con- 
tamination of  food  after  all  cleaning  and  cooking  proc- 
esses are  at  an  end. 

Clmnliness  of  the  hands  of  all  persons  having  to  do 
"d'ith  the  preparation  and  serving  of  food,  and  clean- 
liness of  the  hands  of  the  consumer  himself,  are  im- 
perative if  health  is  to  be  properly  safeguarded. 

Chezv  Your  Food  Well. 

Solid  food  must  become  fluid  before  it  can  enter  the 
blood  and  nourish  the  body.  This  change  is  brought 
about  by  the  digestive  juices  that  nature  provides  for 
that  purpose.  These  digestive  juices  bathe  and  per- 
meate the  entire  mass  of  food  within  the  digestive 
tract,  but  they  can  act  on  any  individual  particle  of 
solid  food  only  from  the  surface.  In  order  that  the 
digestive  juices  may  act  as  speedily  as  possible  on  each 
and  every  particle  of  food  within  the  digestive  tract, 
each  such  particle  must  be  reduced  to  the  smallest  pos- 
sible size,  so  as  to  increase  its  surface  area  in  propor- 
tion to  the  bulk  it  contains.  The  process  is  identical 
with  that  which  we  follow  when  we  desire  to  dis- 
solve rapidly  any  solid  substance,  and  the  reason  is 
the  same  in  both  cases ;  we  cut  it  up  or  break  it  up  into 

(6i) 


WASHINGTON    HEALTH    RULES 

the  smallest  pieces  practicable,  so  that  the  dissolving 
liquid  may  best  attack  it. 

For  the  subdivision  of  food,  nature  has  given  each 
of  us  a  set  of  teeth  and  two  strong  jaws,  but  fre- 
quently we  eat  in  such  a  hurry  that  we  do  not  use 
them.  Then  the  digestive  juices  can  not  act  as  rapidly 
as  they  should,  and  the  food  either  remains  too  long  in 
the  stomach,  where  it  ferments,  or,  before  it  has  been 
properly  prepared  it  is  passed  into  the  intestines, 
where  similarly  objectionable  changes  occur.  If  the 
food  eaten  is  very  indigestible  and  the  particles  in 
which  it  enters  the  stomach  are  large,  we  may  have  an 
attack  of  acute  indigestion,  with  all  of  its  attendant 
discomfort  and  dangers.  If  the  food  is  not  of  such 
an  indigestible  character,  or  if  the  failure  to  chew  it  is 
not  so  great,  then  no  harm  may  result  from  a  single 
error,  but  if  such  faulty  chewing  becomes  a  habit,  then 
chronic  indigestion  must  be  expected  as  the  result. 

Not  all  indigestion  is  due  to  failure  to  chew  food 
properly,  but  it  is  safe  to  say  that  very  much  of  it  is 
due  to  this  cause,  most  frequently  chronic  indigestion ; 
but  there  is  no  sense  in  running  the  risk  of  any  indi- 
gestion whatsoever  simply  to  save  a  few  minutes  at 
meal  time  or  for  the  sake  of  getting  into  the  stomach 
within  a  given  period  more  food  than  can  be  properly 
chewed  within  that  time.  Safety  Lies  in  EfHeient 
Chezving. 

WILLIAM    C.    WOODWARD 


(62) 


BREATHING  AND  EXERCISE 
HEALTH   RULE  VIII 

Breathe  through  your  nose. 

Practice  deep  breathing. 

Sit  and  stand  erect.  Take  plenty  of  out- 
door exercise,  but  avoid  excess  in  athletics; 
it  may  cause  heart  trouble. 

Don't  eat  or  drink  when  overheated  by 
exercise. 

Why  do  zue  breathe  through  the  nosef 

Because  the  nose  is  intended  by  nature  to  convey 
a  column  of  air  into  the  throat  and  through  this  on- 
ward to  the  lungs. 

How  do  we  know  this  to  be  a  fact? 

Primarily,  because  the  nose  is  the  only  permanently 
open  highway  in  the  body  which  leads  to  the  lungs 
through  the  throat. 

Secondarily,  because  within  the  nose  are  placed  cer- 
tain structures  which  through  the  performance  of  their 
normal  physiological  actions  so  modify  and  prepare 
the  inspired  air  as  to  make  it  suitable  for  pulmonary 
respiration. 

Why  should  we  not  breathe  through  the  mouth? 

The  mouth  is  not  a  breathing  passage,  but  a  food 
passage.  As  in  the  nose  we  have  the  structures  for 
preparing  the  air  for  proper  pulmonary  respiration, 
so  in  the  mouth  we  have  the  structures  to  receive  and 
prepare  the  food  for  proper  gastric  digestion. 


WASHINGTON    HEALTH    RULES 

Secondarily,  the  mouth  is  not  a  permanently  open 
highway.  From  a  bacteriological  point  of  view  this 
is  important,  as  bacteria  multiply  freely  in  the  mouth 
but  not  in  a  healthy  nose.  At  birth  we  are  so  con- 
stituted that  the  various  organs  and  systems  of  the 
body,  if  they  are  normal,  perform  their  functions  au- 
tomatically, as  it  were,  and  in  proper  correlation  one 
to  the  other.  Deformities  or  malformations  may  im- 
pair, alter  or  arrest  the  functions  of  any  organ  or 
system. 

To  what  extent  does  deformity  in  the  nasal  organs 
impair  the  process  of  breathing? 

We  may  have  a  congenital  deformity  in  the  nosC; 
that  obstructs  completely  the  nasal  passages  to  the 
conveyance  of  air. 

What  is  the  result  on  the  nezv  born  infant  of  such 
a  condition? 

It  demonstrates  the  fact  most  conclusively  that  the 
nose  is  intended  for  breathing;  and  that  breathing 
through  the  nose  is  the  natural  habit  of  man.  It  also 
demonstrates  the  fact  that  mouth  breathing  is  an  ac- 
quired habit. 

An  infant  born  with  complete  obstructions  to  the 
nose  will  suffocate,  as  many  do,  unless  they  acquire 
themselves,  or  are  taught  to  acquire,  the  habit  of 
breathing  through  the  mouth.  Such  a  child  will 
tighten  the  lips,  draw  in  the  cheeks,  struggle  violently, 
and  become  profoundly  blue  in  the  face  until  when 
forced  to  cry  out  with  pain,  it  will  gain  air  through 
the  mouth,  thus  giving  it  temporary  relief.     With  the 

(64) 


BREATHING   AND   EXERCISE 

temporary  relief  the  mouth  is  firmly  closed  and  the 
process  is  repeated.  Many  in  this  condition  die'  from 
exhaustion  before  they  realize  that  they  must  keep 
the  mouth  open  to  breathe,  or  are  assisted  by  tlieir 
elders  in  acquiring  the   habit. 

We  have  now  demonstrated  that  the  nose  is  the 
proper  channel  through  which  air  passes,  and  have 
also  demonstrated  that  mouth  breathing  is  an  acquired 
habit. 

IVhy  is  it  essential  that  zve  breathe  through  the 
nose? 

Because  in  the  nose  the  air  which  we  breathe  is 
prepared  for  pulmonary  respiration  by  being  warmed, 
moistened,  and  freed  from  coarse  material  therein 
contained  as  well  as  bacteria.  It  has  been  amply 
demonstrated  by  experiments  that  the  inspired  air. 
at  whatever  temperature  the  surrounding  air  may 
be,  is  brought  up  to  nearly  the  temperature  of 
the  body  in  its  passage  through  the  nose.  This  func- 
tion of  the  nose  is  so  nicely  regulated  that  on  a 
winter  day  although  we  may  be  at  one  moment  in 
a  room  with  a  temperature  of  seventy,  the  next  mo- 
ment in  an  outer  room  with  the  temperature  at  forty, 
and  a  few  moments  later  in  the  open  air  with  a  temper- 
ature at  twenty,  or  lower,  the  air  at  all  these  intervals 
is  received  into  the  throat  at  a  temperature  nearly 
equal  to  that  of  the  body  temperature.  The  air  we 
breathe  also  varies  in  its  degree  of  humidity.  All  in- 
spired air  absorbs  moisture  in  its  passage  through  the 
nose.     It  has  been  amply  proved  through  physiolog- 

(65) 


WASHINGTON    HEALTH    RULES 

ical  experiments  that  the  nose  secretes  a  pint  of  fluid 
every  twenty-four  hours  that  is  not  appreciated  as 
moisture  within  the  nose,  which  is  utihzed  in  mois- 
tening the  inspired  air  in  its  passage  through  the  nose. 
It  is  well  known  even  to  the  layman  that  the  nose 
arrests  most  of  the  impalpable  foreign  matter  that 
is  contained  in  the  inspired  air.  This  fact  may  be 
demonstrated.  If,  after  passing  through  a  dust  or 
smoke  laden  atmosphere,  one  wipes  out  the  vestibule 
of  the  nose,  he  will  find  it  surcharged  with  the  dust 
or  soot  which  has  been  therein  arrested.  From  the 
above  fact  it  must  be  recognized  that  the  air  in  the 
first  act  of  respiration  should  not  take  its  course 
through  the  mouth,  that  the  nose  is  the  only  organ  that 
is  capable  of  preparing  the  air  for  pulmonary  respira- 
tion ;  the  mouth  containing  none  of  the  essential  struc- 
tures for  this  purpose. 

What  is  the  result  of  imperfect  nasal  breathing  or 
complete  mouth  breathing  if  maintained  continuously  f 

The  individual  so  affected  becomes  much  more  pre- 
disposed to  acute  and  chronic  affections  of  the  lungs 
and  bronchial  mucous  membranes ;  he  is  also  very 
prone  to  affections  of  the  windpipe  and  larynx ;  he  is 
also  markedly  susceptible  to  acute  and  chronic  catar- 
rhal affections,  and  suppurative  diseases  of  the  middle 
ear;  and  frequently  to  marked  alterations  in  the  de- 
v^elopment  of  the  bones  of  the  face,  resulting  in  undue 
arching  of  the  hard  palate  and  alteration  of  the  out- 
lines of  the  alveolar  process  so  that  there  is  insufficient 

(66) 


BREATHING   AND   EXERCISE 

space  for  the  development  of  the  teeth  with  deformities 
as  a  result  of  the  imperfect  alignment  of  the  latter. 
Hoiv  should  one  maintain  nasal  hreathingf 
One  with  normal  nasal  passages  should  have  no 
difficulty  in  maintaining  nasal  breathing  and  breaking 
the  habit  of  mouth  breathing  if  he  will  resolutely 
strive  to  keep  his  mouth  closed  during  waking  hours, 
except  while  eating  or  talking.  If  one  cannot,  through 
this  simple  means  break  the  mouth  breathing  habit, 
there  must  be  some  intermittent  or  constant  swell- 
ing of  the  soft  tissues,  new  growth,  overgrowth  of 
normally  existing  tissue,  or  bone  deformities  which 
require  correction  by  a  medical  expert. 

How  does  the  manner  in  zvhich  we  stand  and  zvalk 
affect  our  health f 

The  maintainence  of  the  erect  position  with  the  head 
well  poised  and  the  shoulders  drawn  well  back,  not 
only  adds  to  the  physical  grace  of  man,  but  is  also  es- 
sential for  his  physical  well-being.  In  the  athletic 
field  as  well  as  in  the  army  the  erect  carriage  is  con- 
sidered essential  to  obtain  the  full  and  free  action  of 
all  the  organs  of  the  body  so  that  when  under  pres- 
sure they  may  act  with  such  freedom  of  function 
as  to  be  under  no  strain.  In  athletic  training  and 
in  military  service  is  this  fact  so  well  recognized  that 
the  first  efiforts  of  the  trainers  or  the  drill  master  are 
directed  towards  the  correct  carriage  of  the  new  re- 
cruit. The  slouching  habit  is  ungainly,  unattractive 
and  ungraceful.  It  has  also  the  additional  disad- 
vantage that  it  impairs  the  action  of  the  important  in- 

(67) 


WASHINGTON    HEALTH    RULES 

ternal  organs  of  the  body.  The  drooping  of  the  head 
tends,  although  sHghtly,  nevertheless  continuously  to 
impede  the  return  flow  of  blood  from  the  head.  The 
forward  bent  chest  and  depressed  shoulders  prevent 
the  proper  expansion  of  the  lungs  and  necessary  in- 
flation of  the  pulmonary  vesicles.  The  sagging  of  the 
abdomen  allows  'the  stomach,  liver  and  intestines  to 
fall  forward  with  tendency  to  ligamentary  relaxation, 
thus  impairing  their  functions,  and  indeed  occasionally 
causing  displacement  of  these  organs. 

What  does  an  erect  carriage  of  head  and  body  add 
to  our  life? 

It  cannot  be  impressed  upon  the  young  too  s^trenu- 
ously  that  an  erect  carriage  adds  grace,  dignity  and 
physical  beauty  to  an  individual.  It  makes  a  clear 
head,  a  courageous  mien  and  a  better  outlook  upon 
the  world,  all  of  which  are  in  great  part  due  to  the 
better  cranial  circulation,  the  more  perfect  aeration  of 
the  blood  through  improved  pulmonary  circulation  and 
the  more  stable  action  of  the  taut  visceral  organs. 

What  are  the  advantages  of  outdoor  life? 

The  out-of-door  life  has  been  so  thoroughly  brought 
to  the  attention  of  the  public  by  the  physician  through 
preachment  and  example,  and  has  been  so  thoroughly 
taken  to  heart  by  the  public  that  it  hardly  seems  neces- 
sary to  give  extended  consideration  to  this  point,  were 
it  not  that  every  generation  brings  forth  a  certain  pro- 
portion who  coddle  themselves  and  avoid  all  so-called 
physical  exertion  and  outdoor  life.  The  breathing  of 
fresh  uncontaminated  air  is  essential   for  the  proper 


BREATHING   AND    EXERCISE 

aeration  of  the  blood.  The  more  oxygen  in  the  blood 
the  better  is  the  functional  activity  of  every  organ  in 
the  body. 

In  what  manner  is  exercise  most  beneficial? 

In  open  air  exercise  the  benefits  are  obtained  to  the 
greatest  extent.  Under  the  stimulus  of  increased 
muscular  activity,  the  lungs  expand  to  their  full  extent 
and  there  is  a  more  rapid  and  thorough  change  in  the 
residual  air  in  the  lungs.  All  exercise,  whether  in 
the  open  or  within  doors  should  be  of  a  pleasurable 
charadter,  and  have  some  definite  object  in  view.  It 
should  not  be  carried  to  excess  and  should  never 
be  of  a  violent  character.  Excessive  exercise  car- 
ried to  the  extent  of  athletic  competition  is  frequently 
harmful  in  that  when  maintained  over  long  periods  it 
may  give  rise  to  hypertrophy,  or  dilatation  of  the  hearc. 

What  should  he  observed  regarding  eating  and 
drinking  before  and  after  exercise? 

It  is  well  to  bear  in  mind  that  the  partaking  of  food 
and  the  drinking  of  water  should  not  be  indulged  in 
immediately  after  active  or  violent  physical  exertion, 
when  the  body  is  overheated  and  fatigued,  and  that 
we  should  not  take  violent  exercise  immediately  after 
eating  or  drinking.  x-\lways  rest  and  cool  down  after 
exercise  before  eating  and  drinking.  Do  not  attempt 
to  cool  down  quickly  by  exposure  to  drafts  of  cool 
air,  or  by  reclining  upon  cool  or  damp  ground  when 
overheated  and  fatigued  from  exercise. 

CHARLES    W.    RICHARDSON 


(69) 


CARE  OF  THE  TEETH 
HEALTH  RULE  IX 

Clean  your  teeth  in  the  morning  and  at 
bedtime;  use  a  brush  and  prepared  chalk. 

Teeth  decay  principally  during  the  night. 

A  quarter  teaspoonful  of  Milk  of  Magnesia 
taken  without  water  and  kept  in  the  mouth, 
just  before  retiring,  will  help  to  preserve  the 
teeth.      This  applies  even  to  young  children. 

Teeth  should  be  frequently  inspected  by  a 
dentist. 

The  object  of  this  chapter  is  to  give  to  teachers 
and  pupils  instructions  and  reasons  for  proper  care 
of  the  mouth,  or,  as  it  should  be  more  properly  called, 
the  oral  cavity. 

It  is  the  right  of  every  human  being  to  have  as 
perfect  teeth  as  animals,  and  when  living  in  an  un- 
civilized native  state  this  is  usually  the  case,  but  cen- 
turies of  civilization  have  taken  away  the  uncooked 
and  coarse  food  of  the  aborigines  and  given  us  instead 
much  cooked,  machine-prepared  and  predigested  food. 
When  no  resistance  is  offered  the  teeth  in  the  act  of 
mastication  or  the  food  is  swallowed  whole,  the  teeth 
do  not  get  their  share  of  work  and  they  will  deterio- 
rate in  the  same  manner  as  any  other  part  of  the  body 
when  not  exercised.  One  should  chew  food  well, 
because  not  only  is  thorough  mastication  a  great  help 

(70) 


CARE    OF    THE    TEETH 

in  the  preservation  of  teeth  but  besides  helps  diges- 
tion by  mixing  the  food  with  plenty  of  saliva. 

The  oral  cavity  consists  of  the  lips,  teeth,  tongue, 
mouthcavity  and  all  mucous  membrane  surfaces  sur- 
rounding these  parts.  An  unclean  condition  of  the  oral 
cavity  may  be  the  cause  of  a  great  many  ailments, 
especially  of  the  alimentary  tract,  of  which  the  mouth 
is  the  opening.  If  the  mouth  contains  decayed  food 
particles,  or  bacteria,  the  act  of  eating  and  swallowing 
will  convey  them  to  the  alimentary  canal  and  may 
produce  sickness.  Parents  and  teachers  are  doing 
good  work  when  teaching  cleanliness  to  the  children, 
but  a  child  or  adult  can  not  be  considered  clean  if  the 
teeth  are  covered  with  a  green  stain  or  mucus,  or  if 
they  are  vlecayed  and  have  abscesses. 

The  care  of  ithe  oral  cavity  should  begin  with  the 
infant.  Before  each  feeding  the  little  mouth  should  be 
carefully  swabbed  out  with  a  mild  antiseptic  solution 
hke  boracic  acid.  When  the  first  tooth  appears  it 
should  be  cleaned  every  day,  and  the  use  of  the  tooth 
brush  can  begin  at  the  age  of  eighteen  months  or  two 
years.  The  mother  or  nurse  should  use  the  brush  at 
a  regular  time  each  day  in  order  to  form  the  habit. 

The  greatest  care  should  be  given  the  temporary 
teeth  as  upon  them  depend  the  regularity  of  the  per- 
manent teeth  and  the  features  of  the  child.  There 
are  twenty  temporary  or  deciduous  teeth  coming 
through  or  erupting  from  six  months  on,  and  these 
should  be  given  the  same  care  as  to  cleaning,  treating, 
and  filling,  that  is  given  the  permanent  teeth. 

(71) 


WASHINGTON    HEALTH    RULES 

The  next  teeth  to  appear  are  very  important.  They 
are  the  first  permanent  teeth  (called  the  first  or  six 
year  molars)  and  their  position  is  directly  behind  the 
temporary  teeth.  There  are  four, — two  upper  and  two 
lower, — which  erupt  at  the  age  of  six  years.  These 
teeth  are  many  times  mistaken  for  temporary  teeth 
and  should  be  watched  closely,  as  their  loss  means  a 
deficiency  which  cannot  be  supplied  at  that  stage  of 
the  child's  development.  As  the  rest  of  the  teeth 
erupt,  the  temporary  teeth  are  thrown  off  or  ex- 
foliated until  the  entire  set  or  denture  is  completed  at 
twelve  years,  excepting  the  wisdom  teeth,  which  gen- 
erally make  their  appearance  between  the  ages  of 
seventeen  to  twenty-five. 

If  the  mouth  of  the  child  shows  any  tendency  to- 
ward irregularities,  a  competent  dental  practitioner 
should  be  consulted  at  once.  One  of  the  most  com- 
mon of  'these  irregularities  which  can  be  avoided  is 
the  abnormally  high  arch,  due  to  thumb  and  finger 
sucking  and  the  use  of  the  so  called  pacifier.  This 
condition  is  also  said  by  physicians  to  be  the  cause  of 
adenoids.  If  regulating  appliances  are  worn  to  cor- 
rect these  conditions  extra  care  should  be  taken,  be- 
cause the  bands  and  bars  of  ithe  appliance  give  lodge- 
ment to  large  amounts  of  food  rests  or  debris.  This 
also  applies  to  the  adult  who  wears  bridges  or  plates — 
immovable  or  removable.  Food  particles  left  in  these 
localities  ferment  and  putrefy  very  rapidly  owing  to 
the  warmth  and  dampness  found  in  the  mouth  and 
the  product  of  such  fermentation  is  largely  lactic  acid, 

(72) 


CARE    OF    THE    TEETH 

which  is  the  great  destroyer  of  lime  phosphate  or 
the  inorganic  portion  of  which  teeth  consist.  //  an 
extracted  tooth  he  immersed  in  a  dilute  solution  of 
lactic  acid  for  several  days  it  becomes  soft,  shozving 
the  same  action  zvhich  takes  place  in  the  mouth  when 
containing  the  acid.  The  treatment  of  this  condition 
will  he  considered  later. 

The  method  of  cleaning  the  oral  cavity  is  simple 
but  unless  there  is  definite  technique  used  the  effort 
may  be  wasted.  First  friction  must  be  made  with  a 
brush  and  a  paste  or  powder  that  will  polish  but  not 
abraid  the  enamel.  The  brush  selected  should  be 
small  and  of  sufficient  stiffness  for  the  bristles  to  be 
forced  into  the  interdental  spaces  at  the  necks  of  the 
teeth  thereby  scraping  off  the  so-called  mucous 
placques.  These  placques  are  small  particles  of 
mucus  that  are  impregnated  with  lactic  acid.  As  they 
cling  to  the  teeth  they  hold  the  acid  in  contact  with  the 
enamel,  causing  disintegration  and  decay.  The  brush 
for  the  small  child  should,  of  course,  be  very  small 
and  ithe  bristles  not  too  hard. 

The  teeth  must  be  brushed  on  all  surfaces,  using  a 
steady  rotary  motion,  brusliing  the  upper  teeth  down 
and  the  lower  teeth  up.  To  brush  across  the  teeth 
only  is  not  sufficient,  as  only  the  high  spots  are  then 
polished  and  the  spaces  between  the  teeth  remain  un- 
touched. 

The  part  that  is  hardest  to  cleanse  is  the  upper  back 
teeth,  where  the  cheek  is  tight.  In  a  mouth  that  is 
carelessly  cleaned,  food,  mucus  and  tartar  can  always 

(73) 


WASHINGTON    HEALTH    RULES 

be  found  in  this  location.  The  proper  way  to  brush 
this  part  is  to  insert  the  brush  in  the  mouth  and  close 
the  lips  lightly  upon  the  handle,  leaving  the  cheek 
loose,  thus  giving  the  brush  plenty  of  room  to  pass 
entirely  around  the  upper  back  iteeth.  The  lower 
back  teeth  are  easily  cleaned  by  brushing  the  tops  and 
sides,  length-wise  and  cross-wise. 

In  cleaning  the  inside  of  the  teeth  be  sure  and  brush 
from  the  palate  to  the  teath,  also  the  tongue  and  all 
mucous  membrane  surfaces  that  can  be  reached  with- 
out discomfort. 

In  addition  to  water  a  good  dentifrice  advised  by 
the  dentist,  or  plain  prepared  chalk,  must  be  used. 
By  a  dentifrice  we  mean  a  powder  or  paste  to  be  used 
in  conjunction  with  the  tooth  brush  to  mechanically 
clean  the  teeth. 

So  called  antiseptic  mouth  washes  are  usually  not 
efficient,  because  to  kill  bacteria  of  the  oral  cavity, 
they  would  need  to  be  corrosive  enough  to  destroy 
healthy  tissue.  But  it  has  been  found  that  a  mouth 
wash  of  a  decided  alkaline  reaction,  such  as  milk  of 
magnesia  or  lime  water,  is  advisable  for  the  following 
reasons :  Food  particles  between  the  teeth  before  they 
decay  will,  as  stated  before,  ferment,  producing  lactic 
acid,  which,  as  has  been  shown,  disintegrates  the  en- 
amel of  the  teeth.  This  disintegration  takes  place  be- 
fore the  tooth  decays.  The  proper  time  to  brush  the 
teeth  is  night  and  morning,  especially  at  night.  If 
then  the  alkaline  mouth  wash  of  milk  of  magnesia  or 
lime  water,  mentioned  previously,  be  used,  it  will  pre- 

(74) 


CARE    OF    THE    TEETH 

vent  or  retard  decay  better  than  any  other  method. 
In  the  case  of  milk  of  magnesia  the  alkaHne  coating 
chngs  to  the  teeth  for  a  number  of  hours,  preventing 
the  action  of  the  lactic  acid  upon  the  enamel  as  the 
acid  action  is  greatest  during  sleep  when  the  mouth 
is  still  and  the  saliva  is  not  secreting  and  washing  the 
acid  away.  Milk  of  magnesia  should  be  used  nightly. 
The  method  of  using  the  alkaline  mouth  wash  is 
simple.  After  the  teeth  have  been  thoroughly  brushed 
take  a  small  quantity  of  milk  of  magnesia,  say  a  quar- 
ter of  a  teaspoonful,  in  the  mouth,  swallowing  any 
small  surplus.  A  protective  coating  covering  the  sur- 
faces of  the  oral  cavity  will  remain,  and  will,  for  a 
number  of  hours,  neutralize  the  lactic  acid  thereby 
preventing  decay. 

The  use  of  floss  between  the  teeth  is  of  great  benefit, 
as  the  interdental  spaces  can  be  thereby  thoroughly 
polished.  The  floss  should  be  fully  carried  up  between 
the  teeth  and  worked  back  and  forth  until  the  enamel 
has  been  polished.  Great  care  should  be  taken  not  to 
force  the  silk  up  into  the  gum  tissue.  Wooden  or 
quill  tooth  picks  may  be  injurious  to  the  gums  if 
wedged  in  too  tight  or  when  not  fresh  and  clean. 
Pins,  needles  or  metal  toothpicks  should  never  be 
used. 

When  there  are  broken  or  abscessed  roots  and  teeth 
in  the  oral  cavity,  they  should  be  treated  or  removed 
by  a  competent  dentist  as  in  these  roots  bacteria  are 
developed  and  have  been  found  to  cause  infections 
which  extend  throughout  the  entire  body.    There  are  n 

(75) 


WASHINGTON    HEALTH    RULES 

great  many  persons  who  are  in  deadly  fear  of  in- 
fection when  they  have  a  sore  on  any  part  of  the 
body  but  the  same  persons  will  allow  broken  and 
carious  teeth  to  cut  the  tongue  and  cheek,  opening 
the  way  for  malignant  disease. 

Stomatitis — so  called  canker  sores — is  another  evi- 
dence of  the  uncleanliness  of  the  mouth,  usually  ac- 
companied by  disturbed   digestion. 

It  is  only  by  constant  teaching  and  reiteration  that 
the  child  or  adult  will  accept  the  precepts  of  mouth 
hygiene  as  they  do  those  of  the  cleanliness  of  the 
body  in  general. 

ALLAN    SCOTT    WOLFE 


(76) 


LIOUOR  AND  TOBACCO 
HEALTH  RULE  X 

Avoid  tobacco  and  liquors.  They  are  es- 
pecially injurious  to  the  young- 
There  is  good  reason  for  this  advice.  I  beHeve  there 
is  no  doubt  in  the  minds  of  competent  experts,  devoid 
of  prejudice,  regarding  the  soundness  of  this  admoni- 
tion. Tobacco  is  undoubtedly  injurious  to  the  young. 
Personally  I  would  go  still  further  than  this  and  in- 
clude grown  people  also.  I  doubt  if  tobacco  ever  did 
anyone  any  good,  except  the  farmer  who  grows  it 
and  the  railroad  that  carries  it  and  the  manufacturer 
who  prepares  it  for  the  market  and  the  merchant  who 
sells  it.  I  might  include  in  this,  also,  Uncle  Sam,  who 
collects  quite  a  revenue  from  the  tax  on  tobacco.  I 
am  not  one  of  those  who  believe,  however,  that  the 
citizens  should  suffer  harm  to  swell  the  contents  of 
Uncle  Sam's  purse.  As  long  as  people  continue  to 
use  tobacco  I  believe  in  its  taxation,  but  I  wouldn't 
encourage  its  use  in  order  to  increase  the  national 
revenues. 

The  bad  effects  of  tobacco  are  of  two  kinds :  In 
the  first  place,  it  excites  an  unnatural  flow  of  saliva, 
thus  placing  a  burden  upon  the  salivary  glands,  which 
ought  to  be  reserved  for  the  needs  of  nutrition.  It  is 
a  fundamental  principle  in  physiology  that  a  gland 
or  an  organ  of  any  kind,  in  order  to  perform  its  normal 

(77) 


WASHINGTON    HEALTH    RULES 

function,  must  be  properly  kept  in  action.  There  is 
another  fundamental  principle  of  hygiene  and  physi- 
ology, however,  which  is  just  as  important,  namely, 
that  overexertion  of  an  organ  or  a  gland  is  quite  as 
injurious  as  a  lack  of  exercise.  In  so  far  as  the 
excretion  of  saliva  is  concerned,  the  normal  foods 
which  we  eat  are  quite  sufficient  to  give  the  salivary 
glands  their  normal  exercise.  Any  additional  stim- 
ulus, especially  between  meals,  cannot  fail  of  being  in- 
jurious. Thus  tobacco  should  be  condemned  on  the 
same  score  as  chewing  gum,  namely,  as  an  unnatural 
excitant  of  the  glands,  thus  interfering  with  their 
normal  functioning. 

Another  indictment,  however,  holds  against  tobacco, 
namely,  that  it  contains  an  extremely  poisonous  alka- 
loid, nicotine.  I  need  not  go  into  any  discussion  here 
respecting  the  chemical  nature  of  nicotine,  nor  its  rank 
among  poisons.  It  is  universally  admitted  to  be  a 
poison.  When  nicotine  is  ingested  into  the  body,  and 
even  in  the  mouth,  it  is  absorbed  into  the  blood  and  is 
eliminated  principally  by  the  kidneys.  In  the  opinion 
of  some  writers  on  poisons,  complex  chemical  decom- 
positions of  nicotine  occur  in  the  stomach  and  from 
these  there  is  a  resulting  transformation  of  the  gastric 
juices,  which  combined  with  nicotine  are  more  poison- 
ous than  the  simple  tobacco  bases  themselves.  It  is  of 
little  importance  whether  this  theory  is  true  or  not. 
The  well-known  phenomena  of  violent  poisoning,  es- 
pecially in  the  case  of  those  not  accustomed  to  the 
use  of  tobacco,  are  matters  of  universal  knowledge. 

(78) 


LIQUOR    AND    TOBACCO 

As  little  as  one  grain,  sixty  milligrams,  of  nicotine 
is  considered  a  fatal  dose.  Unfortunately,  also,  nico- 
tine is  absorbed  with  great  rapidity.  Therefore  in 
cases  of  intoxication  by  nicotine  there  is  scarcely  any 
possibility  of  the  successful  administration  of  a  remedy. 
The  amount  of  nicotine  contained  in  tobacco  varies 
with  the  locality.  In  American  tobacco  about  two 
per  cent  is  found ;  in  Algerian  tobacco  about  eight 
per  cent.  Many  fatal  cases  of  poisoning  from  tobacco 
have  been  known  among  children,  either  from 
swallowing  tobacco  or  from  playing  with  old  pipes. 
As  small  an  amount  as  one  millig-ram  of  nicotine, 
when  swallowed,  produces  an  unpleasant  sensation  in 
the  mouth  and  throat,  an  excessive  flow  of  saliva, 
and  an  uncomfortable  feeling  extending  from  the 
region  of  the  throat  to  the  extremities  of  the  body. 

It  would  seem  that  no  argument  is  necessary  to 
guard  against  the  use  of  such  a  dreadful  poison.  It 
is  true  that  in  the  ordinary  use  of  tobacco,  either  by 
chewing,  smoking  or  snuff-taking,  relatively  small 
quantities  of  nicotine  enter  the  circulation.  This  is 
extremely  fortunate  from  one  point  of  view,  for  other- 
wise beginners  in  the  use  of  tobacco  would  usually 
end  their  career  suddenly.  The  severe  illness  which 
attends  the  first  attempts  to  use  tobacco,  especially 
in  the  case  of  the  young,  is  a  universal  evidence  of  its 
poisonous  quality.  Whatever  method  of  ingestion  be 
selected,  the  effect  is  usually  the  same. 

The  continued  use  of  tobacco,  beginning  with  very 
small  quantities  and  increasing  to  the  usual  amounts 

(79) 


WASHINGTON    HEALTH    RULES 

employed,  begets  in  the  victim  a  toleration  of  the 
poison,  which  often  is  so  complete  that  very  large 
quantities  of  tobacco  may  be  used  in  the  ordinary 
methods  without  producing  any  of  the  :  immediate 
symptoms  of  poisoning.  The  user  of  tobacco,  how- 
ever, who  says  it  doesn't  hurt  him,  and  there  are  hun- 
dreds of  thousands  of  them  who  say  this,  is  thoroughly 
deceived.  The  development  of  the  tobacco  heart, 
the  production  of  neuroses,  trembling  of  the  hands,, 
the  tendency  to  produce  cancer  of  the  lips,  the  mouth 
and  the  throat,  are  all  well-known  activities  of  tobacco, 
which  are  manifested  particularly  in  those  who  use  it 
for  a  long  period. 

In  so  far  as  youth  is  concerned,  and  I  mean  by 
that  up  to  the  age  of  twenty-one,  there  is  only  one 
safe  course,  namely,  prohibition.  If  the  youth  reaches 
twenty-one  without  forming  the  habit,  he  may  be  re- 
garded as  safely  launched  on  a  tobaccoless  life.  And 
most  fortunate  is  that  boy  or  girl,  now  that  women 
are  commencing  to  use  tobacco,  who  enters  upon  his 
career  free  of  the  bondage  of  the  tobacco  habit.  For 
health,  decency  and  respect  for  the  feehngs  of  others, 
such  a  career  is  most  desirable. 

The  Rule  also  rnentions  liquors.  By  that  I  infer 
alcoholic  liquors.  The  same  precautions  which  have 
been  mentioned  in  respect  of  tobacco  for  the  youth 
apply  with  almost  as  great  force  to  alcohol.  I  say 
''almost  as  great"  for  this  reason:  The  tendency  to 
use  alcohol  by  the  youth  of  the  country  is  far  less 
threatening  and   extensive   than  the   use   of   tobacco. 

(80) 


LIQUOR    AND    TOBACCO 

Alcoholic  beverages  have  become  so  thoroughly  dis- 
credited among  the  people,  the  cause  of  temperance 
and  the  principles  of  prohibition  have  gained  such 
headway,  that  large  numbers  of  our  youth  are  now 
brought  up  without  being  exposed  to  the  acquirement 
of  the  alcohol  habit.  But  still  there  are  many  who  are 
subjected  to  this  danger,  and  it  is  for  those  especially 
that  I  write. 

Alcohol  is  not  so  violently  toxic  as  tobacco,  and  its 
toxicity  shows  entirely  different  aspects  as  a  rule. 
While  alcohol  can  easily  produce  death,  its  first  ef- 
fects are  those  of  pleasurable  exhilaration,  and  this 
is  one  of  the  dangers  in  connection  with  its  use.  It 
is  not  so  much  the  taste  or  flavor  of  the  beverage 
which  is  seductive  as  it  is  the  effect  upon  the  feelings. 
This  of  course  is  true  also  of  tobacco,  though  not 
to  such  a  marked  degree.  Alcohol,  like  tobacco,  is 
always  a  poison.  Unlike  tobacco,  it  has  some  food 
value.  In  other  words,  a  part  of  the  alcohol  ingested, 
if  not  in  too  great  quantities,  will  be  burned  in  the 
body  and  furnish  heat.  To  this  extent  it  is  a  food; 
but  it  is  a  most  expensive  food.  Quite  as  much 
heat  would  be  furnished  by  burning  the  sugar  or 
starch  from  which  the  alcohol  is  manufactured. 

Tobacco  has  one  advantage  over  alcohol  in  this,  that 
as  a  rule,  it  is  not  ingested  directly  into  the  stomach. 
Alcoholic  beverages,  on  the  other  hand,  are  ingested 
directly  into  the  stomach,  so  that  the  full  effect  of 
the  intoxicating  powers  of  alcohol  are  produced.  The 
most  pathetic  phases  of  humanity  are  those  in  which 

(8i) 


WASHINGTON    HEALTH    RULES 

we  find  human  beings  slaves  to  a  dangerous  habit, 
usually  a  drug  habit.  Among  these  the  tobacco  and 
alcohol  habits  are  the  leaders  in  so  far  as  numbers 
are  concerned.  Other  drugs,  such  as  cocaine  and 
opium  and  its  compounds,  have  their  legions  of  slaves, 
but  in  the  case  of  tobacco  and  alcohol  there  is  almost 
at  times,  a  nation-wide  mobilization  of  their  victims. 

Therefore,  while  the  alcohol  habit  has  fewer  dev- 
otees, it  produces  upon  the  whole  far  more  misery 
and  unhappiness.  Tobacco  makes  ill,  but  does  not  de- 
grade. Alcohol  excites  the  worst  passions  of  man. 
In  the  use  of  tobacco  one  does  not  lose  the  use  of 
his  mind.  In  the  use  of  alcohol  in  excess  all  sense  of 
responsibility  ends.  Alcohol  is,  therefore,  far  more 
destructive  than  tobacco. 

Alcohol  has  'far-reaching  effects  on  the  system. 
The  children  of  those  devoted  to  the  use  of  alcohol 
people  the  asylums  of  the  imbecile  and  the  insane. 
The  continued  use  of  alcohol  affects  some  of  the 
vital  organs  of  the  body,  especially  the  liver.  While 
we  speak  of  a  tobacco  heart,  we  should  not  forget 
the  alcohol  liver.  In  reply  to  the  claims  that  are  made 
that  the  moderate  use  of  alcoholic  beverages  that  are 
pure  and  old  tends  to  improve  the  health  and  is  es- 
pecially useful  in  old  age,  I  may  say  that  there  is  no 
sufficient  clinical  proof  to  verify  the  statement.  I,  for 
one,  am  not  of  that  opinion,  but  even  granting  that 
it  is  true,  we  should  leave  to  the  physician  the  ad- 
ministration of  articles  of  this  kind  rather  than  to 
threaten  injury  to  the  great  mass  of  mankind.     I,  for 

(82) 


LIQUOR    AND    TOBACCO 

one,  cannot  see  how  any  kind  of  an  alcoholic  bev- 
erage would  tend  to  prolong  life.  On  the  other  hand, 
victims  of  the  alcohol  habit  are  more  liable  than 
others  to  contract  tuberculosis,  pneumonia,  and  other 
infectious  diseases  and  their  chances  of  recovering  are 
greatly  diminished. 

One  of  the  chief  dangers  in  connection  with  alco- 
holic beverages  is  the  use  of  adulterated  articles,  which 
are  far  more  injurious  tlian  the  genuine  articles.  The 
country  is  flooded  with  so-called  whiskey,  ^brandy 
and  rum,  made  from  alcohol  by  means  of  flavors  and 
colors.  Wine,  especially  sweet  wine,  is  dosed  with 
sugar,  thus  greatly  increasing  its  alcohol  content  to  the 
injury  of  the  consumer.  Beer  is  made  from  glucose, 
so-called  grape-sugar,  and  low  grade  sugars,  and  from 
unmalted  cereals,  when  it  should  be  made  only  from 
malted  cereals  and  hops.  Thus  the  degradation  of 
the  beverages,  cheapening  them,  produces  a  greater 
consumption  of  a  much  more  injurious   material. 

But  even  in  the  case  of  the  genuine  articles  that 
are  properly  aged  I  can  see  no  excuse  for  their  use, 
especially  among  the  young.  Alcohol,  like  tobacco, 
should  be  "malum  prohibitum/'  an  evil  forbidden  to 
youth,  and  I  would  also  add  that  in  so  far  as  I  can 
see  the  same  rule  should  be  applied  to  those  of  mature 


age. 


HARVEY    W.    WILEY 


(83) 


DON'T  NEGLECT   COLDS 
HEALTH  RULE  XI 

Do  not  neglect  coughs  or  colds. 

If  you  do  not  get  well  soon,  go  to  a  doctor 
or  dispensary  for  treatment. 

Never  cough,  sneeze,  or  breathe  in  another 
person's  face. 

Don't  spit  on  floors  or  sidewalks. 

The  popular  term  ''Catching  Cold"  would  often  be 
more  expressive  of  the  real  condition  if  it  were 
changed  to  catching  germs,  which  aptly  denotes  the 
contagiousness  of  the  disease  as  well  as  its  proper 
source. 

Colds  depend  on  one  or  more  of  three  factors 
first,  contact  with  germs ;  second,  lowered  resistance ; 
and  third,  an  exciting  cause,  such  as  drafts  and 
sudden  change  of  temperature.  Bacteria  which  pro- 
duce colds  are  so  prevalent  that  every  precaution 
should  be  taken  to  avoid  them.  One  should  stay  away 
from  all  places  of  crowded  assembly,  such  as  ill-venti- 
lated stores,  theatres,  churches,  street-cars,  etc.  Per- 
sons who  lead  out  of  door  lives  are  less  susceptible 
to  colds  than  those  whose  work  confines  them  indoors, 
for  that  reason  the  hygiene  of  one's  home  or  work- 
ing quarters  is  of  the  greatest  importance.  The  tem- 
perature of  school  rooms  should  never  be  allowed  to 

go  over  68°. 

(84) 


DON'T    NEGLECT    COLDS 

An  efficient  method  of  ventilating  a  room  in  cool 
weather  is  to  lower  the  upper  sashes  a  few  inches 
or  more.  This  will  cause  a  continuous  flow  of 
fresh  air  into  the  room  between  the  two  sashes,  and  the 
exit  of  contaminated  warm  air  at  the  top.  The  intro- 
duction of  fresh  air  not  only  serves  to  increase  our 
supply  of  oxygen,  but  may  often  also  supply  the 
humidity  which  is  so  necessary  and  so  often  lacking 
in  our  modern  dwellings.  The  absence  of  a  proper 
amount  of  moisture  not  only  has  an  enervating  effect 
on  the  whole  system,  but  it  dries  the  mucous  mem- 
brane of  the  upper  respiratory  tract,  causing  irritation 
and  congestion,  thus  producing  favorable  soil  in  which 
bacteria  may  grow  and  produce  disease. 

As  coughs  and  colds  are  often  contagious,  chil- 
dren having  such  symptons  should  be  excluded  from 
school  until  they  have  recovered.  Acute  colds  of  the 
upper  air  passages  occurring  in  a  family,  should  en- 
tail isolation  as  far  as  possible  for  individuals  so 
afflicted,  as  it  has  been  found  that  a  fine  spray  of 
germ  laden  mucus  is  thrown  off  for  a  distance  of 
several  feet  in  the  act  of  coughing,  sneezing  or  laugh- 
ing. This  spray  remains  in  the  air  for  some  time,  thus 
affording  a  favorable  opportunity  for  contact  with  the 
mucous  membranes.  When  coughing,  sneezing  or 
laughing,  a  handkerchief  should  be  held  to  the  nose 
and  mouth  to  catch  the  discharge ;  the  excretions  from 
coughs  and  colds  which  may  contain  billions  of  patho- 
genic organisms  are  also  disseminated  by  expectora- 
tion.    Sputum   is  dangerous  at  all   times,   and  when 

(85) 


WASHINGTON    HEALTH    RULES 

dry  is  converted  into  dust  which  is  scattered  in  the 
atmosphere  by  the  wind,  by  sweeping  and  dusting, 
thus  contaminating  air  and  food  exposed  to  it.  Most 
pathogenic  organisms  retain  their  vitahty  for  long 
periods  of  time  in  dampness,  darkness  and  dirt.  Sun- 
shine, light  and  drying  destroy  them;  for  that  reason 
house  dust  is  very  much  more  dangerous  than  street 
dust.  The  possibility  of  carrying  particles  of  sputum 
into  the  home  on  one's  shoes  and  clothing  and  thus 
conveying  the  infection  must  also  be  taken  into  con- 
sideration. The  direct  rays  of  the  sun  kill  the  tubercle 
bacillus  which  is  the  cause  of  the  Great  White  Plague, 
in  a  comparatively  short  time.  A  war  on  dust  in  our 
homes  would  be  a  war  on  pathogenic  germs  and  con- 
sequently on  disease.  Dry  sweeping  or  dusting  with  a 
feather  duster  does  not  really  clean ;  it  simply  disturbs 
the  dirt,  throwing  it  out  into  the  air  so  that  it  can  be 
readily  inhaled.  The  vacuum  cleaner,  damp  cloths,  and 
specially  prepared  dusters  should  be  our  weapons  of 
attack.  To  prevent  dust  contamination,  careless  ex- 
pectoration should  be  avoided.  Any  one  who  has  a 
sufficient  accumulation  of  mucus  in  the  upper  air 
passage  to  make  it  necessary  to  expectorate,  must 
have  some  diseased  condition  of  the  mucous  mem- 
brane and  should  seek  medical  advice.  Spitting,  due 
to  habit,  is  excessively  vulgar  and  should  not  be 
tolerated.  Spitting  in  public  is  forbidden  by  law  in  a 
great  many  States.  The  discharges  from  the  mucous 
membrane  should  be  received  in  cheese  cloth,  paper, 
handkerchiefs  or  paper  sputum  cups  which  should  be 

(86) 


DONT    NEGLECT    COLDS 

destroyed  by  fire.  The  complete  destruction  of  the 
abnormal  secretions  of  the  respiratory  tract  would 
result  in  a  great  reduction  in  the  frequency  of  a  num- 
ber of  diseases  that  are  now  a  scourge  to  mankind. 

Lowered  resistance,  another  factor  in  colds,  is  of 
equal  if  not  of  greater  importance  than  contact  with 
germs.  One's  resistance  is  of  two  kinds ;  natural  and 
acquired.  Natural  resistance  is  that  which  is  trans- 
mitted by  one's  ancestors.  We  may  inherit  either  a 
family  immunity  or  a  predisposition  to  certain  diseases, 
just  as  we  inherit  certain  features,  dispositions  or 
traits.  For  example,  tuberculosis  is  not  an  inherited 
disease,  but  it  is  conceded  that  a  favorable  soil  may  be 
transmitted  which  when  infection  is  introduced  may 
lead  to  a  rapid  and  fatal  termination. 

Acquired  immunity  is  that  which  we  obtain  by 
hygienic  living,  i.  e.,  pure  air,  sunshine,  good  food, 
proper  clothing,  exercise  and  sufficient  sleep.  There 
are  certain  protective  influences  in  the  body  that  we 
can  increase  and  develop  by  keeping  our  systems  in 
the  highest  possible  state  of  physical  condition,  so  that 
disease  germs  are  harmless  even  if  they  obtain  en- 
trance. When,  owing  to  general  conditions,  these 
mucous  surfaces  have  lost  their  normal  tone,  when 
extreme  changes  of  temperature,  drafts,  wet 
clothes,  fatigue  mental  and  physical,  have  caused  local 
congestion,  tlien  a  suitable  soil  has  been  furnished  for 
dormant  bacteria  to  become  active,  to  develop  and  pro- 
duce disease. 

A  persistant  cough  should  be  considered  a  red- 

(87) 


WASHINGTON    HEALTH    RULES 

flag,  a  danger  signal  to  seek  competent  medical  advice. 
A  cough  may  be  due  to  diseased  conditions  of  the 
nose,  throat,  heart,  lungs  or  kidneys.  It  may  be  the 
beginning  of  tuberculosis,  which  can  only  be  arrested 
in  the  initial  stages.  The  proper  care  of  the  respira- 
tory mucous  membranes,  the  proper  destruction  of 
mucous  discharges,  the  prompt  and  early  treatment  of 
all  diseased  conditions  of  air-passages  not  only  pre- 
vents one  from  becoming  a  menace  to  the  community., 
but  assists  materially  in  assuring  long  life  to  the 
individual. 

WILLIAM   C.  GWYNN 


(88) 


SUNSHINE 
HEALTH  RULE  XII 

Admit  plenty  of  sunshine  into  your  houses 
and  into  your  lives. 

Cultivate  cheerfulness  and    kindliness;     it 
helps  you  to  resist  disease. 

Your  mind  acts  on  your  body. 

Glorious  winter  sunshine  is  about  us  today.  It 
floods  the  ship.  It  lights  up  the  fleecy  clouds.  It 
shines  from  the  great  heaving  expanse  of  the  ocean. 
It  fills  our  hearts  with  cheer.* 

Physical  sunshine  is  one  of  the  therapeutic  agents 
about  which  all  practitioners  agree.  Physicians  of 
every  school  are  apt  to  say  to  a  man  needing  med- 
ical advice,  "Now  get  out  into  the  air  and  sunshine." 

Whatever  else  he  is  to  do  or  not  to  do,  sunshine 
is  usually  added  to  the  cure. 

There  is  a  very  definite  scientific  basis  for  this  be- 
lief in  sunshine. 

In  his  work,  ''Infection  and  Immunity,"  General 
George  M.  Sternberg  says : 

"As  long  ago  as  1877  two  Enghsh  experimenters 
(Downes  and  Blunt)  in  a  communication  made  to  the 
Royal  Society  of  London  presented  evidence  showing 
that   sunlight   has   an   injurious   effect   upon    bacteria, 

(*)  Written  on  shipboard  en  route  to  Belgium  to  assist  in  work  under 
the  American  committee  for  the  relief  of  the  Belgians. 

(89) 


WASHINGTON    HEALTH    RULES 

and  that  sterilization  of  cultures  in  liquid  media  could 
be  effected  by  prolonged  exposure  to  direct  sunlight. 
Since  then  many  experiments  have  been  made  by 
different  observers  and  the  fact  has  been  fully  con- 
firmed. The  distinguished  German  bacteriologist,  Dr. 
Robert  Koch,  reported,  some  years  since,  the  results 
of  his  experiments  with  the  tubercle  bacillus.  He 
found  that  the  time  required  to  kill  this  bacillus  varies 
from  a  few  minutes  to  several  hours,  depending  upon 
the  thickness  of  the  layer  exposed.  Even  diffused 
daylight  exerts  a  certain  germicidal  action,  although 
the  time  of  exposure  is  very  much  longer — five  to 
seven  days  for  the  tubercle  bacillus.  In  the  writer's 
experiments  made  in  1892  it  was  found  that  two  hours' 
exposure  to  direct  sunlight  was  fatal  to  the  cholera 
spirillum  suspended  in  a  liquid  medium. 

"It  has  been  ascertained  that  the  rays  at  the  violet 
end  of  the  spectrum  have  the  greatest  disinfecting 
power,  while  the  red  rays  are  comparatively  inert. 

"The  facts  stated  fully  sustain  the  popular  idea  that 
the  exposure  of  infected  articles  of  clothing  and  bed- 
ding in  the  sun  is  a  useful  sanitary  precaution,  and  is 
to  be  commended  as  a  routine  practice  in  domestic 
sanitation ;  and  also  as  an  additional  and  supplemen- 
tary precaution  when  infected  articles  have  been  sub- 
jected to  the  action  of  other  disinfectants." 

The  germs  of  disease  "love  darkness  rather  than 
light,"  not  only  "because  their  deeds  are  evil,"  but 
because  sunshine  means  sure  death  to  them. 

Nearly  everybody  can  have  sunshine.     The  supply, 

(90) 


SUNSHINE 

for  all  practical  purposes,  is  inexhaustible.  The  phys- 
ical benefit  of  exposure  to  the  sun  is  incalculable. 
Nothing-  but  ancient  prejudice  and  superstition  keeps 
us  from  swimming  in  it  as  we  should. 

There  is  a  lot  of  nonsense  written  about  danger 
from  exposure  to  the  direct  rays  of  the  sun.  Like  the 
superstition  about  night  air,  this  superstition  dies  hard. 
There  are  times  of  intense  summer  heat  when  it  is 
wiser  to  follow  the  example  of  the  inhabitants  of  the 
tropics  and  keep  out  of  the  sun  for  a  few  hours  in 
the  middle  of  the  day.  But,  personally,  I  have  never 
seen  such  times  even  in  Washington  during  July  and 
August.  I  feel  better  to  be  out  in  it  than  lying  back 
in  the  darkness   dreading  it. 

In  a  majority  of  cases  so-called  sunstroke  occurs 
in  persons  who  have  been  imprudent  as  to  overeating 
or  overdrinking  or  overwork  or  worry.  Many  a  cliild 
is  ruined  for  life  by  adoring  parents  who  insist  on 
shielding  it  from  the  sun  and  who  teach  it  from  baby- 
hood to  rush  madly  to  draw  a  hanging,  if  sunlight 
threatens  curtain  or  carpet.  If  it  is  a  choice  between 
the  color  of  a  cheek  or  the  color  of  a  carpet,  wise 
parents  will  choose  the  cheek.     Sunshine  is  a  tonic. 

One  thing  for  which  a  tuberculosis  patient  ought  to 
be  very  thankful  is  this :  The  things  relating  to  a  cure 
are  among  the  choice  things  of  life.  ''Such  a  regi- 
men," said  a  harassed  business  man  who  didn't  have 
tuberculosis,  ''would  give  me  a  chance  to  get  ac- 
quainted with  the  world."  To  sit  and  bask  in  the  sun- 
shine, a  thing  intended  to  be  part  of  the  life  of  every 

(91) 


WASHINGTON    HEALTH    RULES 

normal  man,  is  crowded  out  for  most  of  us  by  the 
pressure  and  rush  of  modern  Hfe. 

In  trying  to  get  over  a  diseased  condition,  there  is 
little  use,  however,  sitting  out  in  physical  sunshine  if 
the  mental  state  is  dark  or  askew.  There  is  no  use  of 
emptying  the  life  of  labor  if  immediately  seven  devils 
of  worry  are  to  rush  in  and  take  possession.  A  man 
had  better  go  on  and  work  till  he  drops,  than  submit 
himself  to  the  tortures  of  unhappy  moods  or  of  a 
worried  mind. 

I  speak  of  this  as  a  matter  of  choosing  and  so  it  is. 
Nobody  need  be  unhappy.  Nobody  need  worry.  It 
is  simply  a  question  of  mental  self-control.  "Two 
kinds  of  things,"  said ,  a  modern  writer,  *T  will  not 
worry  about — the  things  I  can  help  and  the  things  I 
can  not  help.  If  I  can  help  them,  I  will.  If  I  can't 
help  them,  what  is  the  use?" 

In  a  mass  of  literature  on  mental  healing,  there  is 
one  practical  rule  of  immense  assistance  to  all  who 
want  to  stop  worrying.  Put  something  else  in  your 
mind.  Make  yourself  think  of  something  else,  of 
sheep,  camping,  embroidery,  beefsteak,  Bibles,  any- 
thing of  interest  to  you,  and  the  worrying  thought 
will  be  crowded  out. 

What  we  can  not  help,  is  not  our  job.  To  get  well 
if  we  are  sick,  is  our  job  and  it  is  a  man-size  job, — not 
a  job  for  mollycoddles.  If  a  man  hasn't  any  faith 
in  the  universe,  he  can  keep  his  faith  in  courage,  and 
with  every  swelling  impulse  of  courage  comes  a  gleam 
of  mental  sunshine. 

(92) 


SUNSHINE 

Every  true  man  hates  hypocrisy,  but  there  is  some- 
thing to  be  said  in  favor  of  trying  to  appear  cheerful 
whether  we  feel  like  it  or  not.  It  is  so  noble  a  counter- 
feit, and  so  unselfish,  that  it  frequently  ushers  in  the 
reality.  It  makes  others  sunny  and  their  sunshine  is 
reflected  back  upon  us. 

All  this  is  fundamental.  No  cure  is  possible  for 
physical  ill,  if  it  be  tied  up  to  a  mind  bent  on  worry. 

As  well  sit  in  doors  all  day,  and  ship  all  the  fresh 
eggs  to  market  and  eat  only  the  little  a  jaded  appe- 
tite will  accept,  as  to  work  up  an  appetite  in  the  air, 
and  have  the  best  of  food  and  then  block  all  progress 
by  unrest,  unhappiness,  rebellion,   sorrow,   gloom. 

It  zvoidd  seem  as  if  every  discordant  thoiigJit  created 
toxins,  poisons  that  undermine  our  natural  resistance 
to  getting  sick  and  as  if  every  sunny  thought  created 
anti-toxins,  helping  to  increase  this  resistance. 

Mental  and  physical  sunshine  are  essentials  possible 
to  everybody,  without  which  all  the  sanatoria  and 
camps  and  home  cures  are  only  half  efficacious. 

To  cultivate  cheerfulness  and  kindliness  is  a  duty 
we  owe  to  ourselves  and  to  our  neighbors.  Banish 
the  small  thoughts,  think  broadly  and  generously,  and 
let  the  sunshine  of  a  contented  and  sympathetic  heart 
light  up  the  face  which  turns  to  greet  the  world  around 
you. 

JOHN    VAN    SCHAICK,    JR. 


(93) 


WASHINGTON 
HEALTH  RULES 

L 

GOOD  AIR 

Avoid  badly  ventilated,  badly  lighted,  dusty,  dirty,  over- 
heated, crowded  or  damp   rooms. 

II. 
AVOID  HOUSE  DUST 

Breathing  dust,  notably  house  dust,  often  causes  disease. 
Have  no  tacked  down  carpets  and  mattings.  Have  loose 
pieces  or  rugs,  and  clean  them  frequently  outdoors.  Use  a 
hair  broom  for  your  floors  and  keep  lower  sashes  closed  while 
sweeping  or  dusting.  Open  upper  sashes  if  possible.  Never 
sweep  rooms  with  a  broom  that  raises  dust. 

•    III. 
PURE  WATER 

Drink  pure  water.  Avoid  water  from  shallow  and  un- 
protected wells,  and  from  ponds  and  streams.  If  in  doubt, 
boil  the  water.  Washington  water  is  safe  to  drink.  Avoid 
public  drinking  cups, 

IV. 

SAFE  MILK  AND  CREAM 

Tuberculosis,  typhoid  fever,  and  other  diseases  are  often 
caused  by  drinking  raw  milk  and  raw  cream.  Get  milk 
properly  pasteurized,  or  home-pasteurize  it  or  simply  scald  it. 
All  cream,  including  that  used  for  ice  cream  and  butter, 
should  be  properly  pasteurized  to  be  safe. 

V. 
SLEEP 

Get  enough  sleep.  Sleep  with  windows  open  or,  better 
still,  outdoors. 

VI. 

KEEP    CLEAN 

Take  a  bath  or  sponge  daily,  and  a  warm  bath,  followed 
by   a   cold  splash,   plunge,  or  shower,   once  or  twice  a  week 

(94) 


)     ■» 


or  oflencr.  Use  soap  freely.  Wash  your  hands  before 
handling  food.  Don't  put  fingers,  money,  paper,  or  pencils  in 
your  mouth.    Don't  bite  your  fingernails.. 

VII. 
FOOD 

Don't  eat  food  that  has  been  exposed  to  flies  or  dust,  or 
touched  by  unclean  hands.  Raw  fruit  or  vegetables  so 
exposed  should  first  be  rinsed  or  washed  thoroughly.  Chew 
your   food  well. 

VIII. 
BREATHING  AND  EXERCISE 

Breathe  through  your  nose.  Practice  deep  breathing.  Sii 
and  stand  erect.  Take  plenty  of  outdoor  exercise,  but  avoid 
excess  in  athletics ;  it  may  cause  heart  trouble.  Don't  eat  or 
drink  when   overheated  by  exercise. 

IX. 

CARE  OF  THE  TEETH 

Clean  your  teeth  in  the  morning  and  at  bedtime;  use  a 
brush  and  prepared  chalk.  Teeth  decay  principally  during  the 
night.  A  quarter  teaspoonful  of  Alilk  of  Magnesia  taken 
without  water  and  kept  in  the  mouth,  just  before  retiring, 
will  help  to  preserve  the  teeth.  This  applies  even  to  young 
children.     Teeth  should  be  frequently  inspected  by  a  dentist. 

X. 

LIQUOR  AND  TOBACCO 

Avoid  tobacco  and  liquors.  They  are  especially  injurious 
to   the   young. 

XI. 
DON'T  NEGLECT  COLDS 

Do  not  neglect  coughs  or  colds.  If  you  do  not  get  well 
soon,  go  to  a  doctor  or  dispensary  for  treatment.  Never 
cough,  sneeze  or  breathe  into  another  person's  face.  Don't 
spit  on  floors  and  sidewalks. 

XII. 

SUNSHINE 

Admit  plenty  of  sunshine  into  your  houses  and  into  your 
lives.  Cultivate  cheerfulness  and  "kindliness ;  it  will  help  you 
to   resist  disease.     Your  mind  acts  on  your  body. 

(95) 


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